学习曲线早期32例小切口LINK-Sled固定平台膝关节单髁置换疗效观察

Short-term outcomes of minimal invasion LINK-Sled fixed bearing unicompartmental knee arthroplasty in 32 cases of early learning curve

目的建立初学者学习曲线,探讨LINK-Sled固定平台单髁置换手术的安全性及早期效果,总结技术要点、术中容易出现的操作失误并提出改进方法,为缩短学习曲线提供临床经验。方法回顾性分析2022年3月至11月由同一位高年资关节外科医生完成的学习曲线初期的32例LINK-Sled固定平台单髁置换手术病例,记录患者术前及术后4周、6周和3个月时膝关节疼痛视觉模拟评分(visual analogue scale,VAS)和美国特种外科医院(Hospital for Special Surgery,HSS)评分,并观察术后并发症发生情况。采用改良Price膝关节单髁置换术后影像学评分系统评价假体情况。结果32例患者术前VAS平均(3.0±0.7)分、术后4周(1.8±0.5)分,6周(0.9±0.8)分,3个月(0.8±0.7)分;术前HSS评分平均(65.0±7.2)分,术后4周(93.0±2.1)分,6周(94.0±2.4)分,3个月(95.0±2.7)分。术后各随访时间点VAS和HSS评分均较术前有显著性差异(P<0.05);术后4周、6周、3个月的VAS和HSS评分两两比较均无显著性差异(P>0.05)。术后并发症有切口感染2例,术侧小腿肿胀3例,膝关节周围张力性水泡2例,膝关节积血、积液5例,膝关节周围麻木8例。改良Price膝关节单髁置换术后影像学评分平均(28.4±1.3)分。结论LINK-Sled固定平台单髁置换手术对学习曲线早期的病例具有较好的临床疗效,容错率高,并发症少,无垫片脱位风险。初学者应注意术中胫骨截骨后倾角的把控,避免后倾角过大;同时还应注意对间隙松紧度的把控,坚持宁松勿紧的原则,避免因对侧间室压力增高而导致退行性变。

Objective To build a learning curve on the climbing phase of LINK-Sled fixed bearing unicompartmental knee replacement,and to explore the impact on the surgical safety and early outcomes,so as to summarize the technical pearls and pitfalls,and to improve the skills.Methods It was retrospective analyzed in 32 cases of LINK-Sled fixed bearing unicompartmental knee replacement,which performed by the same senior joint surgeon from March to November 2022.Visual analogue scale(VAS)and Hospital for Special Surgery(HSS)score were recorded preoperatively and 4-week,6-week and 3-month postoperatively.The postoperative complications were observed.The modified Price imaging scoring system was employed to evaluate the status of the prosthesis.Results The preoperative,4-week,6-week and 3-month postoperative VAS of 32 cases was 3.0±0.7,1.8±0.5,0.9±0.8 and 0.8±0.7 respectively.The preoperative,4-week,6-week and 3-month postoperative HSS score was 65.0±7.2,93.0±2.1,94.0±2.4 and 95.0±2.7 respectively.The postoperative VAS or HSS score at each point was significantly higher than the preoperative one(P<0.05),but there was no significant difference in postoperative VAS or HSS score between each point(P>0.05).Postoperative complications included 2 cases of incision infection,3 cases of swelling of the lower limbs,2 cases of tension vesicle around the knee,5 cases of hematoma and hydrops and 8 cases of numbness around the knee.The average modified Price imaging scoring system score was 28.4±1.3.Conclusion The early learning curve of LINK-Sled fixed bearing unicompartmental knee replacement has good clinical efficacy,high fault tolerance rate,fewer complications and no risk of bearing dislocation.Beginners should pay attention to avoid an excessive PTS during osteotomy as well as the tightness of the joint space.In terms of"loosen rather than tighten",the pressure increase of the contralateral compartment should be avoided,which will lead to the degeneration.