膝关节锁扣机制在第三代牛津单髁假体置换术中的临床应用研究

Clinical Application of Knee Locking Mechanism in Oxford Fourth Generation Monocondylar Prosthesis Replacement

目的研究膝关节锁扣机制在第三代牛津单髁假体置换术中的临床应用。方法纳入北京清华长庚医院2020年1月至2021年1月收治的膝关节前内侧骨关节炎(anterior medical osteoarthritis,AMOA)患者73例,按照随机数字表法分为常规方法组和新方法组。常规方法组共38例,紧贴前交叉韧带行胫骨垂直截骨,其中男18例,女20例;右膝14例,左膝24例;病程15.3~22.6个月,平均(18.6±3.3)个月;新方法组共35例,胫骨端垂直截骨时较传统方法组平均内旋约5°~10°,其中男20例,女15例;右膝19例,左膝16例;病程14.5~23.8个月,平均(18.8±4.1)个月。按新的手术截骨设计方案安装第三代牛津单髁(Oxford)假体,使用SPSS 26.0软件进行统计分析,比较两种方法在术后美国特种外科医院膝关节功能评分(hospital for special surgery,HSS)、疼痛视觉模拟评分(visual analogue scale,VAS)、西安大略和麦克马斯特大学(the Western Ontario and McMaster Universities,WOMAC)骨关节炎指数及膝关节三维步态上的相关差异。结果术后随访时两组患者的HSS评分、WOMAC评分、VAS评分与术前相比均有改善,差异有统计学意义(P<0.05)。新方法组较传统方法组在术后3 d、1个月、6个月、12个月时HSS评分、WOMAC评分、站立位VAS评分均改善更显著,差异有统计学意义(P<0.05),两组患者术后随访时坐位VAS评分比较差异无统计学意义(P>0.05)。两组患者末次随访时优良率比较,差异有统计学意义(P<0.05)。末次随访时,进行膝关节三维步态分析,新方法组较常规方法组内外旋角度增大,两组比较差异有统计学意义(P<0.05)。结论结合膝关节锁扣机制,胫骨端垂直截骨时较传统方法组平均内旋约5°~10°,术后可使膝关节功能评分更佳,取得更高的优良率。同时,这一方法较常规方法在术后膝关节三维运动上,使得内外旋活动更加接近正常生理运动范围。

Objective To study the clinical application of knee joint locking mechanism in OxfordⅢgeneration unicondylar prosthesis replacement.Methods 73 patients with AMOA admitted to our hospital from January 2020 to January 2021 were divided into two groups according to random number table(conventional method group and new method group).The conventional method group(38 cases)underwent vertical tibial osteotomy against the anterior cruciate ligament,and the new method group(35 cases)had an average internal rotation of about 5°~10°during vertical tibial osteotomy compared with the traditional method group.The OxfordⅢmonocondyle prosthesis was installed according to the new surgical osteotomy design.Statistical analysis was performed using SPSS 26.0 software to compare the results of the two methods in the postoperative hospital for special surgery,HSS,visual analogue scale(visual analogue scale,VAS),western Ontario and mcmaster universities osteoarthritis index(WOMAC)and associated differences in three-dimensional knee gait.Results During postoperative follow-up,the HSS,WOMAC score and VAS of the two groups were improved compared with those before surgery,with statistical significance(P<0.05).HSS,WOMAC score and standing VAS of the new method group were improved compared with the traditional method group at 3 d,1 months,6 months and 12 months after surgery,and the differences were statistically significant(P<0.05).There was no statistically significant difference in sitting VAS between the two groups at postoperative follow-up(P>0.05).There was statistical significance in the excellent and good rate of the two groups at the last follow-up(P<0.05).At the last follow-up,three-dimensional gait analysis of knee joint was performed,and the result showed that the internal and external rotation Angle of the new method was higher than that of the conventional method,and the difference was statistically significant(P<0.05).Conclusion Combined with the locking mechanism of the knee joint,the average internal rotation of the tibial end during vertical osteotomy is about 5°~10°compared with the traditional method,which can improve the functional score of the knee joint and achieve a higher excellent and good rate.At the same time,compared with the conventional method,this method can make the internal and external rotation more close to the normal range of physiological movement.