外侧与内侧单髁置换术治疗膝关节单间室骨关节炎中期临床疗效的对比研究

A comparative study of medium-term efficacy of lateral versus medial unicompartmental knee arthroplasty in treatment of unicompartmental osteoarthritis of the knee

背景:单髁关节置换术(UKA)常用于治疗膝关节单间室骨关节炎(OA)。由于膝外侧间室与内侧间室在解剖学和运动学方面均存在差异,外侧UKA被认为是一种技术难度上更具挑战性的手术。目的:比较膝关节外侧单髁关节置换术(LUKA)与膝关节内侧单髁关节置换术(MUKA)治疗膝关节单间室OA的中期临床疗效。方法:回顾性分析2012年3月至2016年3月接受UKA的265例患者的临床资料,其中Oxford 3活动平台MUKA 189例,LINK-Sled固定平台LUKA 76例。记录两组患者的手术时间、术中出血量、术后引流量、术后并发症等。通过HSS评分、OKS评分、WOMAC指数、FJS评分、膝关节ROM评估临床疗效。通过术后X线片测量影像学评估指标:胫骨假体内外翻角(TCVA)、胫骨假体后倾角(TCPSA)、股骨假体内外翻角(FCVA)、股骨假体屈曲角(FCPSA)。结果:随访时间为4~6年,平均(5.1±0.8)年。与MUKA相比,LUKA的手术时间长、术后引流量少、术后第1日的患肢肿胀程度轻以及膝关节活动度大(P<0.05),两组的术后下地时间、住院天数、手术出血量、术后第3日的患肢肿胀程度比较,差异均无统计学意义(P>0.05)。两组术前与末次随访的HSS评分、OKS评分、WOMAC及FJS评分比较,差异均无统计学意义(P>0.05)。两组的TCVA、TCPSA、FCVA、FCPSA比较,差异有统计学意义(P<0.05)。术后均未见假体无菌性松动、下沉等。MUKA组术后发生衬垫滑脱2例,下肢肌间静脉血栓2例,皮肤浅层感染1例;LUKA组出现1例膝内侧进展性OA,翻修采用MUKA。结论:LUKA技术要求更高,在严格把握手术适应证的基础上,不断提高手术技术,精准把握假体定位和屈伸间隙平衡,避免畸形矫正过度,可以获得与MUKA同样优良的临床疗效。

Background:Unicompartmental knee arthroplasty is commonly used to treat unicompartmental osteoarthritis of the knee.For the anatomical and kinematic differences between the lateral and medial compartments of the knee,lateral UKA is considered to be a technically challenging procedure.Objective:To investigate the medium-term efficacy of lateral versus medial unicompartmental knee arthroplasty in treatment of unicompartmental knee osteoarthritis(UKA).Methods:A retrospective study was conducted on the data of 265 patients with unicompatemental osteoarthritis of knee treated from March 2012 to March 2016,including 189 patients undergoing Oxford 3 mobile-bearing UKA(MUKA)and 76 patients undergoing LINK-Sled fixed-bearing UKA(LUKA).The operation time,intraoperative blood loss,postoperative drainage and complications were recorded.The postoperative clinical outcomes were evaluated by HSS,OKS,WOMAC,FJS and ROM.Postoperative X-rays were used to measure the tibial component valgus/varus angle(TCVA),tibial component posterior slope angle(TCPSA),femoral component valgus/varus angle(FCVA)and femoral component posterior slope angle(FCPSA)for imaging evaluation.Results:All patients were followed up for 4-6 years with the mean of(5.1±0.8)years.There was no statistically significant difference in ambulation time,length of hospital stay,intraoperative blood loss and swelling degree on the third day after the operation between the two groups(P>0.05).There was longer operation time,less postoperative drainage,milder swelling degree on the first day after the operation and greater range of motion of the knee(ROM)in LUKA group compared with MUKA group.There was no statistically significant differences in HSS,OKS,WOMAC and FJS scores before the operation and at the final follow-up between the two groups(P>0.05).There were statistically significant differences in TCVA,TCPSA,FCVA and FCPSA between the two groups(P<0.05).No signs of aseptic loosening and sinking of the prosthesis were found on the X-ray examination after the operation.There were 2 patients bearing dislocation,2 patients of intermuscular vein thrombosis and 1 patient of superficial skin infection in MUKA group,and 1 patient of medial progressive osteoarthritis in LUKA group who received revision by medial UKA.Conclusions:Higher surgical techniques are required in LUKA which can achieve the same excellent clinical efficacy with MUKA based on the strict surgical indications,constantly improved surgical techniques,accurate positioning of prosthesis and balancing of the flexion and extension gap,as well as avoiding overcorrection of deformity.