组配式髌股关节置换联合内侧单髁置换治疗膝关节双间室骨关节炎的早期临床疗效

Early postoperative outcome of bicompartmental knee osteoarthritis treated with modular patellar-femoral arthroplasty and medial compartmental unicondylar knee arthroplasty

目的探讨组配式髌股关节置换联合内侧单髁置换治疗膝关节双间室骨关节炎的早期临床疗效。方法回顾性分析2015年1月至2015年11月北京积水潭医院矫形骨科行髌股关节置换联合内侧单髁置换治疗的膝关节双间室骨关节炎患者共13例(15膝),其中男8例(10膝),女5例(5膝);年龄(54.0±5.6)(40~71)岁;体质量指数(BMI)(26.0±1.7)(20.5~28.7)kg/m2。术后随访12个月以上。采用膝关节疼痛视觉模拟评分(VAS)、膝关节活动度、改良西安大略和麦克马斯特大学(WOMAC)骨关节炎指数评分以及膝关节学会评分(KSS)等相关指标进行评估。各项指标的术前和术后均值间比较采用配对样本t检验。结果术后随访(14.0±2.0)(12~17)个月。未出现严重神经血管损伤、翻修、假体松动、感染、深静脉血栓和假体脱位等需要再次入院的严重并发症。VAS由术前(5.8±1.0)分降至末次随访(1.7±1.3)分(t=10.020,P=0.000)。膝关节活动度由术前(119.0±13.0)°增加至末次随访(128.0±7.0)°(t=-4.104,P=0.001)。改良WOMAC评分由术前(58.4±10.2)分提高至末次随访(92.4±6.2)分(t=-12.433,P=0.000)。KSS临床评分由术前(66.9±11.3)分提高至末次随访(90.6±8.3)分(t=-8.585,P=0.000);KSS功能评分由术前(59.7±9.5)分提高至末次随访(85.0±15.4)分(t=-5.399,P=0.000)。结论组配式髌股关节置换联合单髁置换治疗膝关节双间室骨关节炎,可获得满意的早期疗效,长期临床效果还需要进一步随访研究。

Objective To explore the early postoperative outcome of bicompartmental knee osteoarthritis treated with modular patellar-femoral joint arthroplasty （PFJ） and medial compartmented unicondyl ar knee ar-throplasty （UKA）. Methods Thirteen patients （15 knees） with bicompartmental knee osteoarthritis treated with modular PFJ and medial UKA from January 2015 to November 2015 were reviewed. There were 8 males （10 knees） and 5 females （ 5 knees）, with an age of （54. 0 ± 5. 6） years （40 ？71 years）. The BMI was （26. 0 ± 1.7）kg/m2 （20. 5 ~28.7 kg/m2）. All patients were followed up for at least 12 months. The visual analogue scale （VAS） for knee pain, knee range of motion （ROM） , modified Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC） , and Knee Society Score （KSS） were evaluated preoperatively and at follow-up. Paired sample test was utilized to determine the differences between the preoperative and postoper- ative data. Results The followed-up period was （1 4 .0 ± 2. 0 ） （1 2 ~ 17） months. No patient were lost to the follow-up. There were no severe complications requiring readmission. VAS decreased from preoperative （5. 8 ± 1.0） to （1.7 ±1.3） at last follow-up （f=10.020, P=0.000）. ROM increased from （119.0° ±13.0°） to （128.0° ±7. 0°） （ t= - 4. 104, P = 0 .0 0 1 ） . Modified WOMAC score increased from （5 8 .4 ± 1 0 .2 ） to（92.4 ±6. 2） （f= -12.433, P=0.000） .KSS clinical score increased from （66.9±11.3） to （90.6±8.3） （f= -8.585, p= 0 .0 0 0 ） . KSS functional score increased from （5 9 .7 ±9.5） to （8 5 .0 ± 1 5 .4 ） （f= - 5.399, P=0.0 0 0 ） . Conclusion Short-term effects of combined modular patellar-femoral joint arthroplasty and medial compartmental unicondylar knee arthroplasty for bicompartmental knee osteoarthritis are satisfactory, and the long-term effects still need a further study.