胫骨平台骨赘对单髁置换术力线的影响

Effect of tibial plateau osteophytes on low limb alignment in unicompartmental knee arthroplasty

[目的]探讨单髁置换术中清除胫骨内侧骨赘对术后下肢力线的影响。[方法]回顾性分析2019年12月—2021年12月186例于广东省中医院骨科行单髁置换术患者的临床资料,比较临床测量结果,并分析骨赘与HKA之间的相关性。[结果]与术前相比,术后HKA[(172.9±3.7)°,(177.2±3.1)°,P<0.001]显著增加、骨赘隆起[(3.6±1.9)mm,(0.3±1.0)mm,P<0.001]显著减小。此外,Kennedy分区[0/1/2/C/3,(30/69/66/21/0),(1/20/89/71/5),P<0.001]、骨赘分级[大/中/小,(21/86/79),(0/5/181),P<0.001]显著改善(P<0.05)。术前HKA与术前骨赘值(r=-0.308,P<0.001)呈显著负相关;术前HKA与术前术后骨赘差值(r=-0.256,P<0.001)呈显著负相关;术后HKA与术前骨赘值(r=-0.163,P=0.026)呈显著负相关;术前术后HKA差值与术前骨赘值(r=0.227,P=0.002)呈显著正相关;术前术后HKA差值与术前术后骨赘差值(r=0.239,P<0.001)呈显著正相关。[结论]单髁置换术后下肢力线为轻度内翻,主要影响因素为术前HKA。胫骨内侧骨赘差值不会对术后下肢力线产生明显影响。

[Objective]To investigate the effect of removal of medial tibial osteophytes during unicompartmental knee arthroplasty(UKA)on postoperative lower limb alignment.[Methods]A retrospective study was done on 186 patients who received UKA in our hospital from December 2019 to December 2021.The difference of osteophyte size and hip-knee-ankle angle(HKA)before and after surgery was compared,and the correlation between them was analyzed.[Results]Compared with those preoperatively,the HKA[(172.9±3.7)°,(177.2±3.1)°,P<0.001]increased significantly,while the osteophyte uplift[(3.6±1.9)mm,(0.3±1.0)mm,P<0.001]decreased significantly postopera⁃tively.In addition,Kennedy partition[0/1/2/C/3,(30/69/66/21/0),(1/20/89/71/5),P<0.001]and osteophyte classification[large/medium/small:(21/86/79),(0/5/181),P<0.001]were significantly improved.Regarding correlation,the preoperative HKA was negatively correlated with preoperative osteopathic values(r=-0.308,P<0.001).The preoperative HKA was negatively correlated with preoperative and postopera⁃tive osteophyte difference(r=-0.256,P<0.001).In addition,there was a significant negative correlation between postoperative HKA and pre⁃operative osteophyte value(r=-0.163,P=0.026),whereas a significant positive correlation between preoperative and postoperative HKA dif⁃ference and preoperative osteophyte value(r=0.227,P=0.002),a significant positive correlation between the differences of HKA and osteo⁃phyte before and after surgery(r=0.239,P<0.001).[Conclusion]The alignment of lower limbs after UKA is mild varus,which is mainly in⁃fluenced by preoperative HKA,while the difference of medial tibial osteophytes before and after operation has no a significant impact on postoperative alignment of the lower limb.