Oxford Ⅲ单髁置换治疗内侧间室膝关节炎的疗效观察

Treatment of Medial Compartmental Osteoarthritis of the Knee with Oxford Ⅲ Unicompartmental Knee Arthroplasty

目的本文主要探究运用第3代牛津单髁置换术治疗膝关节内侧间室骨关节炎的早期临床效果与有关手术技术难点。方法回顾性研究2013年12月至2016年12月我科收治的一组20例膝关节内侧间室骨关节炎患者(20膝),其中男8例,女12例;年龄50~74岁,平均62.4岁。患者均存在明确的内侧间室负重疼痛和内侧关节间隙压痛,应力位X线片提示内侧间室呈骨对骨对吻状态,MRI片提示前交叉韧带、后交叉韧带完整。采用微创入路行膝关节内侧间室单髁置换手术,采用美国特种外科医院(the hospital special surgery,HSS)系统对患者手术前、后膝关节疼痛及关节活动度进行评分,从而进一步研究手术适应证的选择及手术技术要点。结果本组20例患者均得到随访,无失访,随访时间平均8个月(4~18个月)。本组患者关节内侧间室疼痛明显减轻或消失,膝关节活动范围:伸直角度平均至-2°(-5°~5°),1例存在5°屈曲畸形;屈曲角度平均至120°(110°~135°);术后复测力线平均2°内翻(0°~6°内翻)。HSS评分由手术前的(69.00±5.63)分增加至手术后的(91.00±5.52)分,优良率达100%,连续满意度调查均为满意。随访期间假体无松动、移位;半月板未发生脱位;无外侧间室和髌股关节病变;无浅表或深部感染、脂肪栓塞或下肢深静脉血栓、骨折等并发症产生。结论第3代牛津单髁置换治疗膝关节内侧间室骨关节炎具有良好的疗效,契合快速康复的理念。

Objective To analyze the cases underwent unicompartmental knee arthroplasty,assess the early outcome,and discuss the indications and the key points of surgical Technique.Methods From December 2013 to December 2016,20 patients diagnosed with medial compartment osteoarthritis of the knee who underwent a primary UKA in our department were included in this study.There were 8 males and 12 females who underwent UKA with an average age at the time of surgery of 62.4 years（range,50 to 74years）.Preoperative weight-bearing long-leg films of the patient were used to show contact of bone of tibia and femor.The anterior cruciate ligament and posterial cruciate ligament were carefully inspected using the MRI,and UKA was performed only if they were intact.The surgical approach for UKA was the minimally invasive medial parapatellar approach.All functional assessments were measured passively with a standard goniometer using Hospital for Special Surgery（HSS）scores.Results All 20 patients were followed up for 8 months（range,4 to 18 months）.The postoperative range of movement in was-2°（range,-5°to 5°）to 120°（range,110°-135°）.The mean flexion/extension femoral component alignment was 2°extension.The HSS was 69（range,60 to 82）preoperatively,and 91（range,80 to 95）postoperatively.None of the patients in the study required revision in the observed period,no joint infection,dislocations,infection.Conclusion UKA is an effective method for medial compartmental osteoarthritis of the knee.Surgery indications and surgical technique are the key factors for the final results.Surgery indications should be broaden：Firstly,no age limitation.Secondly,Not to be engaged in sports or heavy manual labor.Thirdly,the BMI can be to 33 or more.Fourthly,only with medial compartment osteoarthritis.Finally,the anterior cruciate ligament and posterial cruciate ligament were carefully inspected using the MRI postoperatively.