运动学对位对线技术下内侧活动型单髁关节置换的5年以上随访研究

Clinical results of medial mobile bearing unicompartmental knee arthroplasty using kinematic alignment technique with at least 5-years follow-up

目的评估运动学对位对线牛津活动衬垫单髁关节置换技术(OUKA)治疗膝关节骨关节炎的中期疗效。方法回顾性分析中日友好医院2015年6月至2017年1月采用运动学对位对线技术连续进行的最初86例98膝OUKA患者随访5年以上的临床资料。其中男24例28膝,女62例70膝,患者手术年龄为(68.4±8.0)岁。记录并比较患者术前及末次随访的临床资料,对膝关节特种外科医院(HSS)评分、膝关节疼痛视觉模拟评分(VAS)、关节活动度、影像学假体角度及手术并发症等进行评估,分析单髁关节置换运动学对位对线技术的临床效果。结果术后随访(70.9±5.9)个月(60~81个月)。手术时间为(56.4±9.1)min,术中无中转全膝关节置换,无侧副韧带损伤,无骨折。术后住院时间为(5.8±1.9)d。术后血红蛋白下降(12.7±5.5)g/L。围手术期无病例死亡,无输血,无肺栓塞、脂肪栓塞、心脑血管意外等不良事件发生。截止末次随访,所有病例无翻修,无垫片脱位、假体周围感染、假体无菌性松动、对侧间室关节炎进展等并发症。有3例患者报告不明原因的膝关节疼痛。术后HSS评分由(59.1±8.2)分增至(91.8±5.6)分(P=0.019)。关节活动度由122.4°±10.0°增至125.6°±7.1°(P=0.013)。VAS评分由(6.9±0.8)分降至(1.6±1.2)分(P=0.025)。根据OUKA标准,92.9%(91/98)的OUKA假体力线和位置处于理想范围之内,有7膝超出界外。术前负重X线片的髋膝踝角(HKAA)为173.3°±3.7°,术后为177.2°±3.0°(P=0.038)。术后股骨内翻/外翻角A角为2.0°±2.8°(-11°~13°),股骨屈曲/伸展角B角为4.8°±3.4°(0°~17°);术后胫骨假体的内翻/外翻角E角为1.0°±1.9°(-4°~9°),胫骨后倾F角为6.7°±2.3°(1°~12°)。术后假体邻近距离为(4.29±2.46)mm(2~7 mm)。结论运动学对位对线OUKA技术中期疗效满意,假体安装位置满意。

Objective To evaluate the mid-term results of kinematic alignment technique in Oxford mobile bearing unicompartmental knee arthroplasty(OUKA).Methods The clinical data of first 98 knees OUKA performed from June 2015 to January 2017 using kinematic alignment technique with at least 5-year follow-up were retrospectively analyzed,including 28 knees in 24 males and 70 knees in 62 females.The mean surgical age was(68.4±8.0)years.The clinical data of patients before operation and at the last follow-up were recorded and compared.The knee Hospital for Special Surgery(HSS)score,visual analogue scale(VAS)of pain,range of motion,surgical complications and radiological assessment were analyzed to evaluate the efficacy of kinematic alignment technique in OUKA.Results The mean follow-up was(70.9±5.9)months(60-81 months).The mean operation time was(56.4±9.1)minutes.There was no conversion to total knee replacement,no collateral ligament injury and no fracture in operation.The postoperative hospital stay was(5.8±1.9)days.Postoperative hemoglobin drop was(12.7±5.5)g/L.There was no blood transfusion.No patient died during perioperative period.No serious adverse events related to surgery occurred after operation,such as pulmonary embolism,fat embolism,cardio-cerebrovascular accident,etc.No revision,bearing dislocation,periprosthetic joint infection,prosthesis aseptic loosening,contralateral compartment arthritis progression occurred at final follow-up.Three patients reported persistent unexplained knee pain.Afther the operation,the HSS score increased from 59.1±8.2 to 91.8±5.6 after the operation,the range of motion increased from 122.4°±10.0°to 125.6°±7.1°,and the VAS score decreased from 6.9±0.8 to 1.6±1.2(all P<0.05).Radiological assessment showed that 92.9%(91/98)implant positions were ideal and 7 knees were outliers.The mean HKAA was 173.3°±3.7°before surgery and it was 177.2°±3.0°after surgery(P=0.038).The mean A angle of femur varus/valgus angle was 2.0°±2.8°(-11°-13°),and the mean B angle of femur flexion/extension angle was 4.8°±3.4°(0°-17°).The mean tibia valgus/valgus angle E angle was 1.0°±1.9°(-4°-9°),and the mean F angle was 6.7°±2.3°(1°-12°).The mean postoperative prosthesis distance was(4.29±2.46)mm(2-7 mm).Conclusions It′s demonstrated that the kinematic alignment technique follows the design principle of OUKA,has satisfactory mid-term results.The radiological assessment of the prosthesis is acceptable.