术前应用关节镜探查对内侧单髁置换手术疗效的影响

Clinical research of unicompartmental knee arthropalsty combined with arthroscopy

目的探讨膝关节骨性关节炎(OA)内侧单髁置换术中联合关节镜探察的临床疗效.方法通过对36例符合膝关节内侧单髁置换术标准的病例行关节镜辅助内侧单髁置换术,并进行疗效观察.结果所有病例均得到有效随访,所有患者疼痛均得到有效缓解,X片显示假体位置良好,下肢力线恢复,患者膝关节疼痛、畸形均得到缓解,关节活动度良好.膝关节功能评分术前(60.3±5.1)分,术后(91.1±3.2)分,手术前后纽约特种外科医院膝关节评分(HSS)差异有统计学意义(t=30.13,P=0.002);术前关节活动度(105.3±5.6)°,术后关节活动度(116.2±4.2)°,差异有统计学意义(t=10.29,P=0.004);术前负重位内翻角(12.3±3.0)°,术后平均(3.5±2.1)°,差异有统计学意义(t=12.35,P=0.003).结论单髁置换术前应用关节镜,可有效观察膝关节外侧间室、髌股关节结构的完整性,为单髁置换提高证据支持的同时,可以处理外侧间室的半月板、滑膜、游离体,有效改善外侧间室的内环境,减轻关节炎症、卡压、疼痛,进一步提高内侧单髁置换手术疗效.

Objective To explore the clinical effect of arthroscopic exploration in medial unicondylar replacement of knee osteoarthritis (OA). Methods Arthroscopy-assisted medial unicondylar arthroplasty was performed in 36 patients who met the criteria for medial unicondylar arthroplasty of the knee joint, then observe the curative effect. Results All these cases were followed up effectively. All the patients' pain was relieved effectively. X-ray showed that the prosthesis position was good, the lower limb force line was restored, the pain and deformity of knee joint were alleviated, and the range of motion of joint was good. The average score of knee joint function before and after operation was (60.3 ± 5.1) point and (91.1 ± 3.2) point. There were significant differences in knee score (HSS) before and after surgery (t = 30.13, P = 0.002);preoperative range of motion (105.3 ± 5.6)°, and postoperative range of motion (116.2 ± 4.2)°. The difference was statistically significant (t = 10.29, P = 0.004). The preoperative inversion angle of the weight-bearing position (12.3 ± 3.0)°, it was significantly different from that of the postoperatively average (3.5 ± 2.1)°(t = 12.35, P = 0.003). Conclusion Arthroscopy can effectively observe the structural integrity of the lateral compartment of knee joint and patellofemoral joint before unilateral condylar replacement, improve the evidence support for unilateral condylar replacement, at the same time, deal with the meniscus, synovium and free body of the lateral compartment, effectively improve the internal environment of the lateral compartment, and alleviate arthritis, compression, pain and further improve the effect of UKA.