探讨单髁置换术于膝内侧间室骨关节炎的价值

Evaluation of single condyle replacement in medial compartment osteoarthritis of knee

目的探讨单髁置换术治疗膝内侧间室骨关节炎的中短期疗效、髌骨弹响及膝外翻病因。方法回顾性分析2017年7月至2019年5月于浙江大学附属第一医院行单髁置换术的膝内侧间室骨关节炎患者84例(84膝)的临床治疗。采用独立样本t检验比较患者术前及末次随访(术后1年)膝关节功能,内容包括美国纽约特种外科医院膝关节评分(HSS)、膝关节活动度(ROM),视觉模拟疼痛评分(VAS)、下肢力线包括胫骨角(FTA)及髋-膝-踝角(HKA),并记录患者并发症情况。结果所有患者手术切口均为甲级愈合并均获得随访。术后24 h引流量平均(121±81)ml,4例患者接受异体输血治疗,其输血率为4.76%。末次随访患者VAS评分低于术前(t=70.721,P<0.05),末次随访患者HSS评分及ROM均高于术前(t=-37.6、-6.800,均为P<0.05);患者末次随访HKA角度较术前升高(t=-10.965,P<0.05),患者末次随访FTA角度较术前减低(t=14.022,P<0.05)。2例患者出现了屈膝时髌骨弹响,4例患者出现术后膝外翻,并发症患者在末次随访时均自愈。结论单髁置换术治疗膝内侧间室骨关节炎的短期疗效较为满意,但要求术者在手术过程中注意避免并发症。

Objective To investigate the short and medium term curative effect,patella bounce and causes of knee valvular osteoarthritis treated by monocondylar replacement.Methods Eighty-four patients(84 knees)with medial compartment osteoarthritis of the knee underwent unicondylar replacement in the First Affiliated Hospital of Zhejiang University from July 2017 to May 2019.The clinical treatment was retrospectively analyzed.Independent sample t test was used to compare the knee function of the patients before surgery and at the last follow-up(one year after surgery).Hospital for Special Surgery knee score(HSS),knee range of motion(ROM),visual analogue scale(VAS),and lower limb strength line including tibial angle(FTA)and hip-knee-ankle angle(HKA)were measured,and complications were recorded.Results All the surgical incisions were healed at grade A and all the patients were followed up.Twenty-four hours after the operation,the drainage volume was(121±81)ml on average.Four patients received allogeneic transfusion,and the transfusion rate was 4.76%.VAS score of the patients in the last follow-up was lower than that before surgery(t=70.721,P<0.05),and HSS score and ROM of the patients in the last follow-up were higher than that before surgery(t=-37.6,-6.800;both P<0.05).The HKA angle in the last follow-up was higher than that before the surgery(t=-10.965,P<0.05),and the FTA angle in the last follow-up was lower than that before the surgery(t=14.022,P<0.05).Two patients had patella flapping when bending the knee,and four patients had knee valgus after the surgery.All the complications healed by themselves at the last follow-up.Conclusion The short-term efficacy of monocondylar replacement for medial compartment osteoarthritis is satisfactory,but it requires surgeons to pay attention to avoid complications during the operation.