老年人膝关节单髁置换术中联合关节镜探查的应用体会

Application of Arthroscopy in Unicompartmental Knee Arthroplasty of the Elderly

目的探讨单髁置换术(Unicompartmental Knee Arthroplasty,UKA)治疗老年人膝关节骨关节炎时联合膝关节镜探查的意义。方法2011年6月至2017年12月,37例60岁以上老人膝关节内侧间室骨关节炎患者,在UKA中先行关节镜探查。比较术前影像学检查、术中情况,采用KSS评分比较手术效果,探讨60岁以上老人UKA中联合关节镜检查的应用价值。结果术中关节镜探查发现软骨病变主要位于膝关节内侧间室,均达Outerbrige Ⅲ~Ⅳ度,外侧间室关节软骨退变在Outerbrige Ⅱ度及以下者31例,Outerbrige Ⅲ度3例,Outerbrige IV度3例,此6例改行全膝关节表面置换术。37例均有比较严重的内侧半月板损伤。20例髌股关节Outerbrige Ⅰ~Ⅱ度软骨退变,11例合并Ⅲ度退变。8例外侧半月板撕裂,KSS评分:术后与术前KSS膝评分分别为(90.4±6.8)和(55.4±8.3),有统计学差异(t=21.84,P<0.01);术后与术前KSS功能评分分别为(90.3±7.8)与(57.7±7.2),有统计学差异(t=33.39,P<0.01)。根据评分27例疗效优,4例良;关节镜探查清理时间平均(14.54±4.21)min。结论1、对于年龄大于60岁老人,虽然关节镜探查使手术时间延长,但对进一步甄别UKA手术适应证有有益作用,可以探查和处理其它间室病变;2、UKA中进行关节镜探查清理具有一定实用意义。

Objective To explore the application value of arthroscopy in unicompartmental knee arthroplasty(UKA)of the elderly.Methods Arthroscopic exploration and debridementwere performed before UKA on 37 elderly,aged over 60 years,with medial compartment osteoarthritis during the period from June 2011 to October 2017;a comparative study was made to preoperative radiographic examinations,intraoperative performance and postoperative outcomes.Results The lesions were mainly located in the medial compartment of knee with cartilage degeneration of Outerbrige Ⅲ-Ⅳ,31 elderly with lateral articular cartilage normal to cartilage degeneration of Outerbrige Ⅱ,3 elderly with cartilage degeneration of Outerbrige Ⅲ and 3 elderly with cartilage degeneration of Outerbrige Ⅳ(the 6 cases with lateral articular cartilage lesions of Outerbrige Ⅲ-Ⅳ were switched to total knee replacement);medial meniscus tears of different degrees were found in 37 knee joints,20 knee joints were complicated with patellofemoral cartilage degeneration of Outerbrige Ⅰ-Ⅱ and 11 knee joints with patellofemoral cartilage degeneration of Outerbrige Ⅲ;Lateral meniscus tears and degeneration were found in 8 knee joints;there existed a statistical difference between the postoperative KSS knee scores(90.4±6.8)and the preoperative scores(55.4±8.3)(t=21.84,P<0.01),and between the postoperative KSS function scores(90.3±7.8)and the preoperative KSS function scores(57.7±7.2)(t=33.39,P<0.01);based on the scores,27 elderly were of excellent curative effect and 4 were of good;the average time for arthroscopic exploration and debridement were(14.54±4.21)minutes.Conclusions Arthroscopy lengthens operation duration butcontributes to accurate selection of surgical indications;arthroscopy can be applied in examining and dealing with other compartment lesions before UKA;arthroscopic exploration and debridement should be the routine before UKA.