单髁置换优于开式胫骨高位截骨:力学参数及膝关节功能的差异

Unicompartmental knee arthroplasty superior to open-wedge high tibial osteotomy:differences of mechanical parameters and knee function

背景:虽然胫骨高位截骨与单髁置换常被用于治疗单间室病变的内翻膝骨关节炎,但两者术后不同时期的膝关节功能是否存在差异,术前、术后的影像学参数是否有变化,仍需进一步的临床研究。目的:比较单髁置换与开式胫骨高位截骨治疗单间室病变的内翻膝骨关节炎的早期临床疗效及膝关节影像学参数的差异。方法:回顾性分析126例有单间室病变的内翻膝骨关节炎患者的病历资料,其中60例接受结节上开式胫骨高位截骨治疗,66例接受单髁置换治疗。采用美国特种外科医院评估两组患者术前、术后1个月及末次随访的膝关节功能;分别拍摄术前、术后下肢全长站立位X射线片及膝关节正侧位X射线片,测量患者术后髋-膝-踝角、胫骨后倾角、髌骨高度,对比术前、术后两组患者膝关节相关参数的差异。结果与结论:(1)结果共纳入53例胫骨高位截骨患者和61例单髁置换患者,总体随访时长(26.29±3.84)个月;(2)术后1个月,单髁置换组的美国特种外科医院评分高于胫骨高位截骨组(P<0.05);但末次随访时,两组间美国特种外科医院评分相比差异无显著性意义(P>0.05);(3)与同组术前相比,胫骨高位截骨组的髋-膝-踝角、胫骨后倾角均增大(P<0.05),但髌骨高度值减小(P<0.05);与同组术前相比,单髁置换组的髋-膝-踝角增大(P<0.05),胫骨后倾角减小(P<0.05),髌骨高度值增大,但差异无显著性意义(P>0.05);(4)总体髋-膝-踝角由术前(-5.68±3.48)°增大至术后(0.69±0.69)°;两组间术前髋-膝-踝角、胫骨后倾角、髌骨高度值相比,差异均无显著性意义(P>0.05);两组间术后髋-膝-踝角、胫骨后倾角、髌骨高度值及Δ髋-膝-踝角(术后-术前)、Δ胫骨后倾角(术后-术前)、Δ髌骨高度(术后-术前)相比,差异均有显著性意义(P<0.05);(5)提示胫骨高位截骨和单髁置换患者在末次随访时均获得满意的效果,但术后1个月的膝关节功能评分方面,单髁置换组表现更优;相比之下,胫骨高位截骨容易出现术后髌骨低位以及胫骨后倾角增大;单髁置换术后髌骨高度未见明显改变,但胫骨后倾角出现明显的减小。

BACKGROUND:Although high tibial osteotomy and unicompartmental knee arthroplasty are often used to treat unicompartmental knee osteoarthritis with varus deformity,whether there are differences in knee function at different postoperative periods and whether there are changes in knee parameters on preoperative and postoperative imaging still need further clinical study.OBJECTIVE:To compare the early clinical efficacy and the differences in knee imaging-related parameters of unicompartmental knee arthroplasty and open-wedge high tibial osteotomy in the treatment of unicompartmental knee osteoarthritis with varus deformity.METHODS:The medical record data of 126 patients with unicompartmental knee osteoarthritis with varus deformity were retrospectively analyzed,including 60 patients undergoing open-wedge high tibial osteotomy and 66 patients undergoing unicompartmental knee osteoarthritis with varus deformity.The Hospital for Special Surgery knee score was used to assess knee function preoperatively,1 month postoperatively and the late follow-up between the two groups.Long-leg full-weight-bearing radiograph and anteroposterior and lateral radiograph of knee were taken before and after operation.The postoperative hip-knee-ankle angle,tibial posterior slope and patel ar height were measured.The differences in the relevant imaging parameters of knee joint were compared between the two groups before and after operation.RESULTS AND CONCLUSION:(1)A total of 53 knees with high tibial osteotomy and 61 knees with unicompartmental knee arthroplasty were included in this study.The overall follow-up time was(26.29±3.84)months.(2)The Hospital for Special Surgery scores were higher in the unicompartmental knee arthroplasty group than those in the high tibial osteotomy group(P<0.05).At the last follow-up,there was no significant difference in Hospital for Special Surgery scores between the two groups(P>0.05).(3)Compared with preoperative data in the same group,the hip-knee-ankle angle and tibial posterior slope increased(P<0.05),but patellar height decreased(P<0.05)in the high tibial osteotomy group.Compared with preoperative data in the same group,hip-knee-ankle angle increased(P<0.05),but tibial posterior slope decreased(P<0.05),patellar height increased in the unicompartmental knee arthroplasty group,but the difference was not significantly different(P>0.05).(4)Total hip-knee-ankle angle increased from(-5.68±3.48)°preoperatively to(0.69±0.69)°postoperatively.No significant difference was detected in hip-knee-ankle angle,tibial posterior slope and patellar height between the two groups before operation(P>0.05).Significant differences were found in hip-knee-ankle angle,tibial posterior slope,patellar height,Δhip-knee-ankle angle(postoperation-preoperation),Δtibial posterior slope(postoperation-preoperation)andΔpatellar height(postoperation-preoperation)between the two groups after operation(P<0.05).(5)It is concluded that the two groups of patients obtained satisfactory results in the late follow-up.However,the patients in the unicompartmental knee arthroplasty group had better knee function scores 1 month after surgery compared with the high tibial osteotomy group.In contrast,the high tibial osteotomy group was prone to postoperative patellar baja and increased posterior tibial slope.In the unicompartmental knee arthroplasty group,the patellar height did not change significantly after surgery,but the posterior tibial slope showed a significant decrease.