牛津全生物型假体膝关节单髁置换的早期临床疗效

Research of early outcomes of cementless Oxford unicompartmental knee arthroplasty

目的 探讨牛津全生物型假体膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)治疗膝关节前内侧骨关节炎的早期临床疗效.方法 回顾性分析2020年1月至2021年6月在福州市第二医院关节外科90例接受UKA手术治疗膝关节前内侧骨关节炎患者的临床资料.根据假体固定方式的不同分为两组,全生物型UKA者45例,男22例、女23例,年龄(65.6±7.0)岁(范围52~81岁);骨水泥型UKA者45例,男21例、女24例,年龄(67.9±6.1)岁(范围55~79岁).比较两组患者手术时间、术中出血量和住院时间.采用疼痛视觉模拟评分(visual analogue scale,VAS)、纽约特种外科医院膝关节评分(hospital for special surgery,HSS)、遗忘关节评分(forgotten joint score,FJS)评价膝关节手术前后疼痛及术后关节功能状况.观察两组患者术后假体周围透光线、透光区出现的数量以评估术后假体稳定性.通过测量患者手术前后胫骨近端内侧角(medial proximal tibial angle,MPTA)、机械轴偏向(mechanical axis deviation,MAD)评估下肢力线的改善情况.结果 两组患者性别、年龄、体质指数等基线资料的差异均无统计学意义(P>0.05).两组患者均获得至少18个月的随访.全生物型组患者手术时间为(97.8±21.1)min、术中出血量为(70.8±37.6)ml,优于骨水泥型组(P<0.05);而住院时间的差异无统计学意义.两组患者术后各时间点VAS评分、HSS评分、MPTA和MAD均优于术前(P<0.05).全生物型组术前及术后 6、12、18 个月时 VAS 评分分别为 7.0(6.0,7.5)分、4.0(3.0,5.0)分、2.0(2.0,3.0)分、2.0(1.0,3.0)分,HSS 评分分别为56(53,60)分、78(75,82)分、85(80,89)分、86(82,90)分;术后6、12和 18个月 FJS评分分别为66.0(63.0,68.0)分、73.0(70.5,76.0)分、76.0(74.0,78.0)分.术前两组患者VAS评分、HSS评分的差异无统计学意义(P>0.05),仅术后6个月时两组患者VAS评分的差异有统计学意义(P<0.05);术后6、12和18个月时全生物型组患者HSS评分、FJS评分均优于骨水泥型组(P<0.05).全生物型组术前及术后6、12、18个月时MPTA分别为85.41°(84.22°,86.54°)、85.80°(84.74°,87.41°)、86.51 °(85.47°,88.14°)、86.80°(86.09°,88.27°);MAD分别为2.29(1.79,2.65)cm、1.11(0.69,1.75)cm、1.02(0.65,1.66)cm、0.91(0.61,1.63)cm.除全生物型组术前MPTA大于骨水泥组,全生物型组术后6,12个月MAD小于骨水泥组(P<0.05)外,其余各时间点两组患者MPTA、MAD的差异均无统计学意义(P>0.05).随访期间全生物型组患者假体周围各区域生理性透光线数量为3个,明显少于骨水泥型组的28个(P<0.05),两组患者均未见假体周围出病理性透光线.结论 全生物型UKA治疗膝关节前内侧骨关节炎可明显改善关节疼痛、矫正膝关节畸形,且具有手术时间短、创伤小及患者术后主观感受更好的优势.

Objective To assess the early clinical outcomes of Oxford cementless unicompartmental knee arthroplasty(UKA)in the management of anteromedial osteoarthritis of the anterior medial knee(AMOA).Methods A retrospective review was conducted on a cohort of 90 patients who underwent primary UKA for AMOA at the Fuzhou Second Hospital between January 2020 and June 2021.The patients were divided into two groups based on the type of prosthesis used:the cementless UKA group and the cemented UKA group.The cementless UKA group included 45 patients(22 males and 23 females),with a mean age of 65.6±7.0 years(ranging from 52 to 81 years).The cemented UKA group consisted of 45 patients,including 21 males and 24 females,with a mean age of 67.9±6.1 years(ranging from 55 to 79 years).The study compared various parameters between the two groups,including the duration of surgery,amount of blood loss,length of hospitalization,pain visual analogue scale(VAS)scores,Hospital for Special Surgery(HSS)scores,and forgotten joint score(FJS).Additionally,radiolucency around the prosthesis,medial proximal tibial angle(MPTA),and mechanical axis deviation(MAD)were observed and measured before and after surgery to assess prosthesis stability,improvement of knee deformity,and knee joint mobility,respectively.Results Both groups were followed up for a minimum of 18 months.No statistically significant differences were found in demographic data such as gender,age,and body mass index between the two groups.The cementless UKA group demonstrated superior results in terms of shorter duration of surgery(97.8±21.1 min)and less blood loss(70.8±37.6 ml)compared to the cemented UKA group(P<0.05).However,no significant difference in length of stay was observed between the groups.Postoperative VAS scores,HSS scores,MPTA,and MAD were significantly improved compared to preoperative values in both groups(P<0.05).The median VAS scores for the cementless UKA group at 6,12,and 18 months postoperatively were 4.0(3.0,5.0),2.0(2.0,3.0),and 2.0(1.0,3.0)respectively.The corresponding median HSS scores for the cemented UKA group were 78(75,82),85(80,89),and 86(82,90)preoperatively and at 6,12,and 18 months postoperatively,respectively.The median FJS scores for the cementless UKA group were 73.0(70.5,76.0),76.0(74.0,78.0),and 66.0(63.0,68.0)preoperatively and at 6,12,and 18 months postoperatively,respectively.There was no statistically significant relationship between preoperative VAS scores and preoperative FJS scores(P>0.05).However,there was a significant difference in VAS scores between the two groups at 6 months postoperatively(P<0.05).The cementless UKA group consistently exhibited better VAS scores and HSS scores compared to the cemented UKA group at 6,12,and 18 months postoperatively(P<0.05).The median MPTA values for the cementless UKA group were 85.41°(84.22°,86.54°),85.80°(84.74°,87.41°),86.51°(85.47°,88.14°),and 86.80°(86.09°,88.27°)preoperatively and at 6,12,and 18 months postoperatively,respectively.The median MAD values for the cementless UKA group were 2.29(1.79,2.65)cm,1.11(0.69,1.75)cm,1.02(0.65,1.66)cm,and 0.91(0.61,1.63)cm preoperatively and at 6,12,and 18 months postoperatively,respectively.There were no significant differences in MPTA and MAD between the two groups at all time points,except for the preoperative MPTA and postoperative MAD at 6 and 12 months.The incidence of physiological radiolucency around the prosthesis was significantly lower in the cementless UKA group 3 than in the cemented UKA group 28(P<0.05).However,no complete radiolucency was observed in either group.Conclusion Oxford cementless UKA is a highly effective treatment for relieving joint pain and correcting knee deformity in patients with knee AMOA.It offers the advantages of shorter surgical duration,reduced blood loss,and improved subjective outcomes for patients after the operation.