单髁与全膝关节置换术治疗膝内侧骨关节炎术后步态对比研究

Comparative study of postoperative gait analysis on unicompartmental and total knee arthroplasties in treatment of medial compartmental knee osteoarthritis

目的探讨单髁膝关节表面置换术(UKA)与全膝关节置换术(TKA)术后患者及正常膝关节在斜坡行走时的三维步态运动学差异,为指导膝关节置换术后功能康复治疗提供科学依据。方法选取2014年6月至2016年5月就诊于广州医科大学附属第一医院骨科行膝关节置换术患者23例(24膝),按手术方式不同分为UKA组12例(12膝)和TKA组11例(12膝)。纳入标准:膝关节内侧骨关节炎,前交叉韧带完整,非术侧下肢无严重疾病。排除标准:慢性肺部疾病、缺血性心脏病、神经系统疾病、身体质量指数(BMI)大于28。健康对照组12例(12膝),男女各6例,平均(25±3)岁。UKA组男性4例,女性8例,平均(65±8)岁;TKA组男性5例,女性6例,平均(64±8)岁。术后疗效主观评分采用牛津膝关节评分系统(OKS)。利用红外光导航膝关节三维动态评估系统(Opti_knee)采集参试者在倾斜度为7°的斜坡上下坡行走时胫骨相对于股骨活动的6个自由度数据,比较三组术后步态参数的变化差异。OKS评分结果的比较采用独立样本t检验,年龄、BMI、术后6个自由度最大值及活动范围的比较采用单因素方差分析和LSD-t检验。结果 UKA组平均OKS评分比TKA组低,组间差异具有统计学意义(P<0.05)。UKA组外翻、外旋、屈曲角度最大值及内外翻、屈伸角度活动范围比健康对照组小,差异均有统计学意义(P<0.05)。TKA组外翻、外旋、屈曲角度最大值及内外翻、内外旋、屈伸角度活动范围比健康对照组小,差异均有统计学意义(P<0.05)。UKA组外翻角最大值和内外翻角度活动范围比TKA组大,差异均有统计学意义(P<0.05)。TKA组上位移、内位移最大值及上下位移、内外位移活动范围比健康对照组小,但前位移、后位移最大值及前后位移活动范围比健康对照组大,差异均有统计学意义(P<0.05)。UKA组前位移、后位移最大值及前后位移活动范围比TKA小,上位移最大值及上下位移活动范围比TKA大,差异均有统计学意义(P<0.05)。结论在三维步态中UKA术后患者比TKA术患者在胫骨相对于股骨的运动学角度和骨位移活动范围上更接近正常膝关节步态。

Objective To investigate the differences between the patients of unicompartmental knee arthroplasty（UKA） and total knee arthroplasty（TKA） in three-dimensional（3D） kinematics of knee joint in slope walking.Methods Twenty-three patients（24 knees） undergone keen arthroplasty in the Department of orthopedics of the First Affiliated Hospital of Guangzhou Medical University from June 2014 to May 2016 were divided into the UKA group of 12 cases（12 knees） and the TKA group of 11 cases（12knees）.Inclusion criteria：medial compartmental knee osteoarthritis with intact anterior cruciate ligament and without severe disease in the contralateral lower limb.Exclusion criteria：chronic pulmonary disease,ischemic heart disease,neurological diseases or body mass index（BMI） 〉28.Twelve healthy volunteers（12 knees） were recruited from the hospital as normal control group including six males and six females with the average age of（25 ± 3） years.The UKA group included four males and eight females with the average age of（65 ± 8） years; The TKA group included five males and six females with the average age of（64 ± 8） years.Six degrees of freedom of the tibia relative to the femur during walking down the slope of7° slant were collected from the three groups and analyzed by the 3D dynamic evaluation system using the infrared optical navigation（Opti-knee）.The UKA group and the TKA group were scored by the Oxford knee scoring system（OKS）.One-way ANOVA was applied in age,BMI and the maximal ranges of six degrees of freedom; t test was applied in OKS scores comparison.Results The average OKS score of UKA group was lower than TKA group,and the difference was statistically significant（P 〈0.05）.Both the UKA group and the TKA group presented smaller data in the maxima of valgus angle,external rotation angle,the flexion angle,and the ranges of varus-valgus,angles and flexion-extension angle than the control group,the differences were statistically significant（P 〈0.05）.In the UKA group,the maximum valgus angle and the range of varus-valgus angles were larger than the TKA group; the differences were statistically significant（P 〈0.05）.The range of internal-external rotation angle in the TKA group was smaller than the control group; the difference was significant（P 〈0.05）.The maxima of proximal displacement,the medial displacement and the ranges of proximal-distal displacement and medial-lateral displacement in the TKA group were smaller than the control group,but the maxima of anterior displacement and posterior displacement,as well as the range of antero-posterior displacement were larger than the normal control group; the differences were statistically significant（P 〈0.05）.the maxima of anterior displacement and posterior displacement,as well as the range of antero-posterior displacement in the UKA group were smaller than the TKA group; the maximum proximal displacement and the range of proximal-distal displacement in the UKA group were larger than the TKA group; the differences were statistically significant（P〈 0.05）.Conclusion In the 3D gait analysis,UKA may provide kinematic characteristics more similar to the normal knee gait than TKA.