膝关节外侧间室软骨退变对膝关节内侧单髁置换手术的影响

Impact of cartilage degeneration in lateral compartment of knee joint on medial unicondylar knee arthroplasty

目的探讨膝关节外侧间室软骨退变对膝关节内侧单髁置换手术的影响。方法选择2018年6月至2020年6月以来在我院接受膝关节内侧单髁置换手术治疗的108例膝关节外侧间室软骨退变患者,应用Altman分级以及Ahlback评分有效评估患者膝关节影像学的具体退变状况,并根据术前X线片检查结果的Kell-gren-Lawrence分级进行分组,分为外侧正常组、外侧退变组、内侧正常组以及内侧退变组各27例。观察分析四组术前及术后末次随访时的OKS评分、AKS评分。结果两组患者OKS评分比较差异无统计学意义(P>0.05),末次随访时两组OKS评分之间比较,差异无统计学意义(P>0.05);两组术前OKS评分比较,内侧退变组得分比内侧正常组明显较高,差异无统计学意义(P>0.05),末次随访时内侧退变组得分压迫高于内侧正常组,但差异无统计学意义(P>0.05);术前外侧退变组AKS评分要高于外侧正常组,但差异无统计学意义(P>0.05),且末次随访时外侧退变组AKS评分要低于外侧正常组,差异有统计学意义(P<0.05);术前内侧正常组AKS评分要低于内侧退变组,但差异无统计学意义(P>0.05),且末次随访时内侧正常组OKS评分要高于内侧退变组,差异无统计学意义(P>0.05)。结论膝关节外侧间室软骨退变并不会对UKA手术治疗的效果造成较大影响,且患者经临床检查后发现存在膝关节外侧间室软骨退变并不能成为决定患者是否能接受手术治疗的一项绝对禁忌证。

Objective To investigate the impact of cartilage degeneration of lateral compartment of knee joint on medial unicondylar knee arthroplasty(UKA).Methods A total of 108 patients with cartilage degeneration of lateral compartment of knee joint who received medial UKA in our hospital from June 2018 to June 2020 were selected as research objects.Altman classification and Ahlback score were used to evaluate the specific degeneration of knee joint by the imaging.According to Kell-gren-Lawrence of preoperative X-ray examination results,the patients were divided into the lateral normal group,lateral degeneration group,medial normal group and medial degeneration group,with 27 cases in each group.OKS scores and AKS scores of the four groups before operation and at the last follow-up after operation were observed and analyzed.Results There was no significant difference in OKS scores between the two groups(P>0.05).There was no significant difference in OKS scores between the two groups at the last follow-up(P>0.05).Before operation,OKS score was significantly higher in the medial degeneration group than that in the medial normal group,with no significant difference(P>0.05).At the last follow-up,the OKS score was higher in the medial degeneration group than that in the medial normal group,with no significant difference(P>0.05).AKS score was higher in the lateral degeneration group than that in the lateral normal group before operation,with no statistically significant difference(P>0.05).AKS score was lower in the lateral degeneration group than that in the lateral normal group at the last follow-up,with statistically significant difference(P<0.05).AKS score was lower in the medial normal group than that in the medial degeneration group before operation,with no statistically significant difference(P>0.05).OKS score was higher in the medial normal group than that in the medial degeneration group at the last follow-up,with no statistically significant difference(P>0.05).Conclusion The cartilage degeneration in lateral compartment of knee joint will not greatly affect the efficacy of UKA,and the existence of cartilage degeneration in lateral compartment of knee joint after clinical examination cannot be an absolute contraindication to determine whether patients can receive surgical treatment.