前交叉韧带MRI异常患者单髁膝关节置换随访分析

Follow-up analysis of unicompartmental knee arthroplasty in patients with abnormal anterior cruciate ligament on MRI

目的探讨术前膝关节核磁共振(MRI)前交叉韧带(ACL)异常结果对单髁膝关节置换术(UKA)疗效影响。方法本研究采用t检验、秩和检验、方差分析等统计方法,回顾性分析广州医科大学附属第一医院关节外科2014年5月至2019年5月收治的单髁膝关节置换术治疗膝前内侧骨关节炎患者。纳入标准:确诊膝关节前内侧骨关节炎、膝关节MRI提示除内侧间室软骨磨损、ACL异常外结构正常、术中直视下仅前内侧软骨磨损且ACL功能完整。排除标准:多间室骨关节炎、类风湿关节炎、感染性关节炎。通过术前膝关节MRI结果上显示ACL的情况,分为ACL-MRI正常组、ACL-MRI异常组。共55例患者(61膝),其中26例(30膝)ACL完整,29例(31膝)ACL异常。对两组分别采用美国特种外科医院膝关节评分(HSS)、疼痛视觉模拟评分(VAS)及膝关节活动度(ROM)对术前及末次随访时膝关节功能进行评估,并观察两组术后有无假体的松动、感染,垫片有无磨损、脱位等并发症。结果所有患者获得随访,随访最长时间5年,平均随访(21±17)个月。术后ACL-MRI正常组末次随访时HSS评分平均(75.9±7.6)分、VAS评分平均1.0(0.7,1.3)分、ROM平均(109.9±9.9)°;术后ACL-MRI异常组末次随访时HSS评分平均(77.7±6.6)分、VAS平均0.8(0.6,1.1)分、ROM平均(108.0±10.6)°均较术前有明显改善。两组在膝关节活动度、膝关节HSS评分及疼痛评分上差异无统计学意义(P>0.05)。两组在术后并发症上均未出现假体感染、松动、脂肪栓塞,垫片磨损、脱位等并发症。结论术前MRI显示ACL异常但术中未见ACL断裂、其功能良好者UKA术后短中期疗效好,长期结果尚需随访。

Objective To investigate the incluence of abnormal anterior cruciate ligament(ACL)MRI on the efficacy of unicompartmental knee arthroplasty(UKA).Methods This study used statistical methods such as t test,rank sum test,and analysis of variance to retrospectively analyse the patients with anterior medial knee osteoarthritis treated by UKA admitted from May 2014 to May 2019 in the department of joint surgery of The First Affiliated Hospital of Guangzhou Medical University.Inclusion criteria:diagnosed anteromedial knee osteoarthritis,knee MRI showed only medial compartment cartilage wear and ACL abnormality,intra-operative findings showed only anterior medial cartilage wear while ACL function was normal.Exclusion criteria:multi-compartment osteoarthritis,rheumatoid arthritis,infectious arthritis.The MRI results showed ACL conditions,which were divided into ACL-MRI normal group and ACL-MRI abnormal group.A total of 55 patients(61 knees),of which 26 cases(30 knees)had complete ACLs,and 29 cases(31 knees)had abnormal ACLs.For the two groups,the Hospital for Special Surgery knee score(HSS),visual analogue scale(VAS)and range of motion(ROM)were used to evaluate the knee joint functions before operation and the last follow-up situation after operation respectively.Whether the prosthesis was loosening or infected after the operation,and whether the gasket had abrasion,dislocation or other complications,were also observed.Results All the patients were followed up for the longest time of five years,with an average follow-up time of(21±17)months.At the last follow-up of normal ACL-MRI group after surgery,the average HSS score was(75.9±7.6).The average VAS score was 1.0(0.7,1.3),and the average ROM was(109.9±9.9)°.Postoperative ACL-MRI was abnormal at the last follow-up of the group.The average HSS score was(77.7±6.6).The average VAS score was 0.8(0.6,1.1),and the average ROM was(108.0±10.6)°.All the data were significantly improved compared with the preoperative scores.There was no statistically significant difference between the two groups in knee range of motion,knee HSS score and pain score(P>0.05).No complication such as prosthesis infection,loosening,fat embolism,gasket wear,or dislocation occurred in the two groups.Conclusion The patients with preoperative abnormal ACL MRI but the ACL is confirmed unbroken and good function during operation may have good short-term and mid-term effects after UKA,which still needs follow-up for the long-term results.