髌股关节退变对膝关节内侧单髁置换术后疗效的影响

Influence of patellofemoral degeneration on outcome after medialunicompartmental knee arthroplasty

目的探讨髌股关节骨关节退变(PF-OA)对牛津(Oxford)活动平台膝关节内侧单间室置换术后膝关节功能的影响。方法回顾性分析自2017年5月至2019年4月间在河南省洛阳正骨医院膝关节外科行单间室置换术的患者70例。依据髌股关节退变程度的Ahlback分级,将患者分为无髌股关节退变组(无PF-OA组,25例)、内侧髌股关节退变组(内侧PF-OA组,28例)和外侧髌股关节退变组(外侧PF-OA组,17例)。采用视觉模拟评分(VAS)、牛津膝关节评分(OKS)及美国特种外科医院(HSS)关节功能评分对手术前后膝关节的疼痛和功能进行评价。VAS、OKS、HSS评分在同一时间点组间比较采用单因素方差分析,组间两两比较方差齐者采用LSD检验,不齐者采用Game-Howell检验,同组治疗前后比较采用配对t检验,性别等计数资料组间比较采用卡方检验。结果与术前比较,末次随访时无PF-OA组、内侧PF-OA组和外侧PF-OA组患者VAS评分均明显降低(t=27.26、31.80、20.88,均为P<0.05);OKS评分降低(t=-27.11、-28.43、-15.04,均为P<0.05);HSS评分提高(t=-17.66、11.08、10.06,均为P<0.05)。随访终末,3组间VAS评分及OKS评分差异无统计学意义(均为P>0.05),HSS评分3组间差异有统计学意义(Fw=10.28,P<0.01)。末次随访时外侧PF-OA组HSS评分低于内侧PF-OA组(ω2=0.36,P<0.01)及无PF-OA组(ω2=0.30,P<0.01);内侧PF-OA组及无PF-OA组间HSS评分差异无统计学意义(P>0.05)。结论内侧髌股关节退变不影响膝关节内侧单髁置换临床疗效,不应作为UKA的禁忌证。外侧髌股关节退变虽可对UKA疗效有影响,但术后患者膝关节疼痛及功能仍有明显改善,从这一角度讲,对外侧髌股关节退变为AhlbackⅡ及Ⅲ级的特定人群,仍可接受UKA手术。

Objective To investigate the effect of patellofemoral osteoarthritis(PF-OA)on the knee functions aftermedialunicompartmental knee arthroplasty(UKA)for medial knee osteoarthritis on the Oxford active platform.Methods Seventy patients underwent UKA at the Luoyang Orthopedic-Traumatological Hospital(Orthopaedic Hospital of Henan Province)between May 2017 to April 2019 were retrospectively analyzed.Based on the Ahlback classification of patellofemoral degeneration,the patients were divided into the no patellofemoral degeneration group(non PF-OA group,25 patients),the medial patellofemoral degeneration group(medial PF-OA group,28 patients)and the lateral patellofemoral degeneration group(lateral PF-OA group,17 patients).visual analogue scale(VAS),Oxford knee joint score(OKS)and hospital for special surgery knee score(HSS)were used to evaluate the pain and function of knee joint before and after operation.The VAS,OKS and HSS scores were compared between groups at the same time point using one-way ANOVA,and the LSD test was used for two-way comparisons between groups where the variance was the same,and the Game-Howell test was used for those data variance were not the same.ResultsCompared to the preoperative period,the patients in the non PF-OA,medial PF-OA and lateral PF-OA groups at the final follow-up had significantly lower VAS scores(t=27.26,31.80,20.88,all P<0.05);lower OKS scores(t=-27.11,-28.43,-15.04,all P<0.05);HSS scores were also improved(t=-17.66,11.08,10.06,all P<0.05).At the end of follow-up,the differences in VAS scores and OKS scores among the three groups were not statistically significant(all P>0.05)and the differences in HSS scores among the three groups were statistically significant(Fw=10.28,P<0.01).HSS scores in the lateral PF-OA group were lower than those in the medial PF-OA group(ω2=0.36 P<0.01)and the non PF-OA group(ω2=0.30,P<0.01)at the last follow-up,and the difference was statistically significant(P<0.05);HSS scores difference between the medial PF-OA and non PF-OA groups was not statistically significant(P>0.05).Conclusions Degeneration of medial patellofemoral joint does not affect the clinical outcomes of UKA for medial knee osteoarthritis,and should not be regarded as a contraindication for UKA.Although the degeneration of lateral patellofemoral joint may have a negative effect on the clinical outcomes of UKA,the knee function after the operation is still markedly improved.UKA can still be performed in the specific population with lateral patellofemoral joint degeneration of AhlbackⅡandⅢgrade.