牛津活动平台单髁置换术治疗膝关节自发性骨坏死的疗效分析

Efficacy of Oxford Mobile platform Unicompartmental Knee Arthroplasty in the Treatment of Spontaneous Osteonecrosis of the Knee

目的探讨牛津活动平台单髁置换术治疗膝关节自发性骨坏死的临床疗效。方法回顾性分析上海交通大学医学院附属松江医院骨科自2017年1月至2021年7月采用牛津活动平台单髁置换术治疗的30例膝关节自发性骨坏死患者,男7例,女23例;年龄62~80岁,平均(70.20±4.39)岁;左膝11例,右膝19例。术前通过X线和MRI对患者进行诊断和分期,记录并评价术前、末次随访时膝关节的功能、疼痛和下肢力线改善情况。结果全部患者均获随访,随访时间为12~36个月,平均为(26.43±7.18)个月。疼痛视觉模拟评分术前(6.63±1.07)分,术后末次随访(1.17±0.95)分,差异有统计学意义(P<0.05),术后疼痛明显缓解;美国特种外科医院膝关节评分术前(63.03±5.76)分,术后末次随访(93.33±2.81)分;牛津大学膝关节评分术前(44.07±3.05)分,术后末次随访(21.37±2.91)分,差异有统计学意义(P<0.05);膝关节功能显著提高,全部为优。膝关节术前最大活动度(120.73±3.89)°,术后末次随访(121.43±2.74)°,差异无统计学意义(P>0.05);术前股胫角(178.6±1.98)°,术后末次随访(174.8±0.71)°,差异有统计学意义(P<0.05),下肢力线得到纠正;术前胫骨平台后倾角(6.9±1.06)°,术后末次随访(7.2±0.55)°,差异无统计学意义(P>0.05)。结论牛津活动平台单髁置换术治疗膝关节自发性骨坏死,具有保留更多的骨量和软组织、创伤小、出血少、本体感觉恢复快、改善下肢力线、术后功能恢复好和并发症少等优点,临床疗效满意。

Objective To investigate the clinical efficacy of Oxford mobile platform monocondyle arthroplasty in the treatment of spontaneous osteonecrosis of the knee.Methods From January 2017 to July 2021,30 patients with spontaneous osteonecrosis of the knee underwent unicompartmental knee arthroplasty.7 males and 23 females were included.The patients age from 62 to 80 years,with an average of(70.20±4.39)years.There were 11 cases of left knee and 19 cases of right knee.The patients were diagnosed and staged by X-ray and MRI before operation.The functional and pain of knee joint and the improvement of lower limb alignment at the last follow-up were recorded and evaluated.Results All patients were followed up for 12 to 36 months,with an average of(26.43±7.18)months.The visual analogue score was(6.63±1.07)before operation and(1.17±0.95)at the last follow-up after operation(P<0.05),and the difference was statistically significant.The American Hospital for Special Surgery knee score was(63.03±5.76)before operation and(93.33±2.81)at last follow-up.The Oxford knee score was(44.07±3.05)before operation and(21.37±2.91)at last follow-up(P<0.05),and the difference was statistically significant.The knee function was significantly improved,with all of them were excellent.The maximum range of motion was(120.73±3.89)°before operation and(121.43±2.74)°at the last follow-up(P>0.05),and the difference was not statistically significant.Tibial femur angle was(178.6±1.98)°preoperatively and(174.8±0.71)°postoperatively(P<0.05),and the difference was statistically significant.The lower limb alignment was corrected.The posterior Angle of tibial plateau was(6.9±1.06)°before operation and(7.2±0.55)°at the last follow-up(P>0.05).The difference was not statistically significant.Conclusion Oxford mobile platform monocondylar replacement for spontaneous osteonecrosis of the knee has the advantages of preserving more bone mass,less soft tissue trauma,less bleeding,rapid proprioceptive recovery,better functional recovery and fewer complications after lower extremity line surgery.The clinical efficacy is satisfactory.