活动平台单髁置换术治疗膝关节内侧间室骨关节炎的中长期随访

Long-Term Follow-up Analysis of Severe Medial Compartment Knee Osteoarthritis on the Treatment of Mobile Bearing Unicompartmental Knee Arthroplasty

目的:总结活动平台单髁置换术(Unicompartmental Knee Arthroplasty,UKA)治疗膝关节内侧间室骨关节炎的中长期随访。方法:回顾性分析活动平台单髁置换术手术5年以上的膝关节内侧间室严重骨关节炎患者64例(69膝),依据术前和末次随访时膝关节视觉模拟评分法(VAS)疼痛评分、美国纽约特种外科医院膝关节评分(Hospital for Special Surgery Knee Score,HSS)和牛津膝关节评分(Oxford Knee Score,OKS),评价单髁置换术治疗膝关节内侧间室严重骨关节炎的中长期临床疗效。依据术前及末次随访时膝关节正侧位X线片,记录是否出现外侧间室严重骨关节炎、假体松动、活动衬垫脱位以及衬垫磨损等并发症,并计算单髁置换术中长期假体生存率。结果:64例患者中59例(63膝)获得随访,平均随访(8.6±2.1)年,末次随访时膝关节VAS评分由术前(5.82±1.18)分降至(0.86±1.02)分,美国纽约特种外科医院膝关节评分由术前(58.24±7.38)分升至(90.25±6.92)分,牛津膝关节评分由术前(19.36±5.82)分提高至(41.38±2.78)分,组间比较差异均有统计学意义(P<0.001)。末次随访时3例患者行翻修手术,原因分别为胫骨平台假体无菌性松动、单髁置换术术后膝外翻畸形和活动衬垫脱位,末次随访时未出现因外侧间室严重骨关节炎及假体严重磨损而翻修的病例。5~12年随访假体生存率为95.2%。结论:活动平台单髁置换术治疗膝关节严重内侧骨关节炎中长期随访疗效满意,能够缓解膝关节疼痛并改善膝关节功能,但须严格掌握手术适应证并且具备良好的手术技术。

Objective:To investigate the medium to long-term clinical,functional and radiographic outcomes of mobile bearing unicompartmental knee arthroplasty(UKA)in treating severe medial compartment knee osteoarthritis.Methods:A retrospective analysis was conducted in 64 patients who suffered from severe medial compartment knee osteoarthritis and underwent UKA before December 2016.Visual analogue scale(VAS),hospital for special surgery knee score(HSS)and oxford knee score(OKS)were evaluated to assess the clinical efficacy of UKA at the time before surgery and the last follow-up.In addition,based on knee joint plain radiographs at the last follow up,complications like prosthesis loosening,dislocation,wear and severe osteoarthritis of other compartment were recorded among all enrolled patients.Results:59 out of 64 patients were followed up for(8.6±2.1)years.VAS decreased from 5.82±1.18 preoperatively to 0.86±1.02 at the last follow up(P<0.001).The HSS and OKS increased from 58.24±7.38 and 19.36±5.82 preoperatively to 90.25±6.92 and 41.38±2.78 at the last follow-up after surgery respectively(P<0.001).Additionally,3 patients were revised by UKA and changing mobile bearing insert,the etiologies of these patients were prosthesis loosening,mobile bearing insert dislocation and knee joint valgus defomity,there was no case of severe lateral compartment osteoarthritis and wear of prosthesis that needed revision operation.The survival rate of prosthesis was 95.2% after 5 to 12 years follow-up.Conclusion:Satisfactory medium to long-term therapeutic outcomes could be achieved by UKA for treating severe medial compartment knee osteoarthritis.UKA can well relieve knee joint pain and improve knee joint function.