活动与固定平台单髁假体对膝关节前内侧骨关节炎的疗效比较

Comparison of Clinical Efficacy of Mobile Bearing and Fixed Bearing Unicompartmental Knee Arthroplasty in Unicompartment Arthritis Knee

目的观察活动与固定平台的单髁假体置换(unicompartmental knee arthroplasty,UKA)在膝关节单间室骨关节炎中的临床应用效果。方法选择2018年1月至2019年1月收治的84例膝关节前内侧骨关节炎患者,随机分为对照组与观察组各42例。对照组采用Link固定平台UKA治疗,男20例,女22例;年龄52~88岁,平均(68.16±5.28)岁;左膝13例,右膝29例;身体质量指数(23.51±3.82)kg/m^(2);术前关节平均屈曲角度(115.62±5.49)°。观察组采用Oxford活动平台UKA治疗,男23例,女19例;年龄48~89岁,平均(68.37±5.43)岁;左膝14例,右膝28例;身体质量指数(23.54±3.75)kg/m^(2);术前关节平均屈曲角度(115.58±5.37)°。观察并记录膝关节功能、疼痛、关节活动度、并发症发生情况。结果两组患者术后24个月美国膝关节协会评分(knee society score,KSS)、美国特种外科医院(hospital for special surgery,HSS)膝关节评分均高于术前(P<0.05)。两组术后24个月HSS评分、KSS评分比较差异无统计学意义(P>0.05)。两组术后疼痛视觉模拟评分(visual analogue scale/score,VAS)均低于本组术前(P<0.05),组间比较差异无统计学意义(P>0.05)。两组术后胫股角(femoral tibia angle,FTA)、胫骨平台后倾角(sagittal tibial Angle,STA)较本组术前显著缩小(P<0.05)。术后关节最大屈曲角度、关节最大伸直角度明显优于术前(P<0.05),组间比较差异有统计学意义(P<0.05)。两组术后感染、假体松动、衬垫脱位、关节出血及纤维化、关节炎进展等并发症发生率比较差异无统计学意义(P>0.05)。结论活动平台与固定平台UKA治疗膝关节内单间室骨关节炎均可改善患者膝关节功能,减轻疼痛程度,改善关节活动度,不良反应发生率低。

Objective To observe the clinical application effect of Unicompartmental Knee Arthroplasty(UKA)with mobile bearing and fixed bearing platforms in single-compartment arthritis of the knee joint.Methods 84 patients with anteromedial knee arthritis admitted from January 2018 to January 2019 were selected and randomly divided into a control group and an observation group,with 42 cases in each group.The control group was treated with Link fixed bearing UKA.and there were 20 males and 22 females;age 52 to 88 years,with an average age of(68.16±5.28).There were 13 left knees and 29 right knees.The body mass index was(23.51±3.82)kg/m^(2).And the average Knee Flexion Angle(KFA)before surgery was(115.62±5.49)°.In the observation group,23 men and 19 women were treated with Oxford mobile bearing UKA.The age ranged from 48 to 89 years,with an average of(68.37±5.43)years.There were 14 left knees and 28 right knees.The body mass index was(23.54±3.75)kg/m^(2).And the mean preoperative KFA was(115.58±5.37)°.Knee function,pain,range of motion and the occurrence of complications were observed and recorded.Results The HSS scores and KSS scores of the two groups were higher than the preoperative scores at 24 months after surgery in both groups(P<0.05).There was no significant difference in HSS score and KSS score between the two groups at 24 months after operation(P>0.05).The postoperative Visual Analogue Scale/Score(VAS)of the two groups were lower than those of the preoperative group(P<0.05),and there was no statistically significant difference between the groups(P>0.05).The postoperative FTA and sagittal tibial Angle(sTA)were significantly smaller in both groups than before surgery(P<0.05).The maximum KFA and the maximum knee extension angle were significantly better than those before the operation(P<0.05).The difference between the groups was statistically significant(P<0.05).There was no statistically significant difference between the two groups in the incidence of postoperative complications such as infection,prosthesis loosening,liner dislocation,joint bleeding and fibrosis,and arthritis progression(P>0.05).Conclusion Both the mobile and fixed bearing platform UKA can improve knee joint function,relieve pain,improve joint mobility,and reduce the incidence of adverse reactions in the treatment of unicompartment arthritis in the knee joint.