髌股关节软骨退变程度对单髁置换术后效果的影响

Effect of different degrees of patellofemoral joint cartilage degeneration on outcome of unicompartmental knee arthroplasty

目的:探讨髌股关节软骨退变程度对内侧活动平台单髁置换术短期疗效的影响。方法:回顾性分析2017年1月至2018年12月在深圳市人民医院因前内侧骨关节炎行内侧活动平台单髁置换或全膝关节置换术的75例患者资料,依据术中探查髌股关节软骨退变情况分为无退变单髁组(无退变组)、内侧退变单髁组(内侧退变组)、内外退变单髁组(内外退变组)和内外退变全膝组(全膝组)。单因素方差分析对比4组患者术前术后牛津大学膝关节评分(OKS)、美国特种外科医院(HSS)评分、骨关节炎指数(WOMAC)评分,并记录终末随访时有无假体松动、脱位、力线改变等情况。结果:所有患者获得随访,随访时间平均(36±10)个月。4组患者术后OKS评分、HSS评分、WOMAC评分较术前均有改善(F=18.555,P<0.001;F=5.867,P=0.001;F=22.671,P<0.001);术前术后OKS、HSS、WOMAC评分差值,无退变组与内侧退变组之间差异均无统计学意义(均为P>0.05),内外退变组与无退变组、内侧退变组相比,功能改善程度稍差(均为P<0.05),内外退变组与全膝组之间OKS、HSS、WOMAC评分差值差异无统计学意义(均为P>0.05)。所有病例于末次随访时无假体松动、脱位、力线改变。结论:内侧髌股关节软骨退变对内侧活动平台单髁置换术后疗效影响不大,但面对外侧髌股关节软骨退变时则需慎重,此时选择单髁或是全膝,需个性化考虑。

Objective To investigate the effect of different degrees of patellofemoral joint cartilage degeneration on short-term outcome of medial mobile-bearing unicondyle knee arthroplasty.Methods The data of 75 patients who underwent medial mobile-bearing unicondyle knee arthroplasty(UKA)or total knee arthroplasty(TKA)for anteriormedial osteoarthritis in Shenzhen People's Hospital from January 2017 to December 2018 were retrospectively analyzed.According to the intraoperative exploration of patellofemoral joint cartilage degeneration,the patients were divided into four groups:no patellofemoral joint degeneration+UKA group(the non-degeneration group),the medial patellofemoral joint degeneration+UKA group(the medial degeneration group);the medial and lateral patellofemoral joint degeneration+UAK group(the medial-lateral degeneration group);the medial and lateral patellofemoral joint degeneration+TKA group(the TKA group).The preoperative and postoperative Oxford knee assessment scores(OKS),Hospital for Special Surgery(HSS)knee scores,and the Western Ontario and McMaster Universities(WOMAC)osteoarthritis index scores of the four groups were compared and analyzed by one way AN OVA.The prosthesis loosening,dislocation,and force line changes were recorded during the final follow-up.Results All the patients were followed up for(36±10)months on average.The postoperative OKS,HSS,and WOMAC scores of the four groups were improved compared with those before operation(F=18.555,P<0.001;F=5.867,P=0.001;F=22.671,P<0.001).Comparing the differences of OKS,HSS and WOMAC scores before and after the surgery,there was no statistically significant difference between the non-degeneration group and the medial degeneration group(all P>0.05).Compared with the non-degeneration group and the medial degeneration group,the function improvement of the medial-lateral degeneration group was slightly worse,and the difference was statistically significant(all P<0.05).The difference in OKS,HSS,and WOMAC scores between the medial-lateral degeneration group and the TKA group was not statistically significant(all P>0.05).No prosthesis loosening,dislocation,or force line change was found at the final follow-up.Conclusions Medial patellofemoral joint degeneration has little effect on the outcome after medial mobile-bearing UKA.Cautions should be taken with the lateral patellofemoral joint cartilage degeneration,choosing UKA or TKA should be individually considered.