应力位片结合关节镜探查在单髁置换术中的应用

The application of stress radiograph combined with arthroscopy in unicompartmental knee arthroplasty

目的探讨应力位摄片结合关节镜探查在膝关节前内侧骨关节炎的诊断和单髁置换患者选择中的应用价值。方法回顾性分析2011年6月到2014年6月,我科361例预手术患者(431膝)接受应力位摄片检查诊断为膝关节前内侧骨性关节炎(Anterior medial osteoarthritis,AMOA),计划进行单髁置换手术治疗(UKA)。如诊断不明确,术中先行关节镜检查。应力位摄片诊断的准确性由术中所见进行验证。UKA术后患者随访20至48个月(平均30.9个月),采用美国膝关节协会评分(KSS评分)评估术后膝关节功能。结果 395个膝关节符合AMOA诊断,36膝术前手术指征存疑在术前行关节镜检查,其中11膝更改手术方式。应力位摄片诊断AMOA的准确率为91.6%,如以最终UKA为标准,准确率为97.4%。25例经关节镜探查后行UKA治疗的患者术后KSS膝评分(93±5)分较术前(56±7)分有统计学差异(=33.49,<0.05);KSS功能评分(94±6)分较术前(54±9)分有统计学差异(=30.78,<0.05)。结论应力位X片作为一个确定UKA适应症的重要指标,它的准确性存在一定的偏差,关节镜能够协助明确单髁置换手术适应征。

Objective To explore the application value of stress radiograph combined with arthroscopy in the diagnosis of knee’s anterior medial osteoarthritis and the choice of the patient eligible to unicompartmental knee arthroplasty. Methods A retrospective analysis on 361 patients with 431 knees during the period from Jun 2011 to Jun 2014. They are pre-diagnosed as anterior medial osteoarthritis, AMOA, through stress radiograph examination and ready to accept unicompartmental knee arthroplasty. If the diagnosis is not clear enough, an arthroscopy is arranged before the operation. The diagnosis accuracy of stress radiograph is verified during the operation. The patients were followed up for 20 to 48 months （averagely 30.9 months）, and the KSS score was used to evaluate the function of the knee joint. Results 395 knees in 431 meet the AMOA diagnosis. 36 knees, of which the preoperative surgical indications are not clearly identified, accepted preoperative arthroscopy and 11 knees changed the surgical approach. The diagnostic accuracy of the stress radiograph in AMOA was 91.6%, and 97.4% if taking UKA as criterion. The postoperative KSS knee score （93±5） of the 25 patients who had arthroscopy before UKA treatment and the its preoperative KSS knee score （56±7） have significant difference （t= 33.49, P〈0.05）. The KSS function score （94±6） and the preoperative score （54±9） have significant difference （t = 30.78, P〈0.05）. Conclusion As an important index to determine the indication of UKA, the stress radiograph has a certain deviation. Arthroscopy, as a minimally invasive examination, can assist in the identification of unicompartmental knee arthroplasty surgery.