膝关节单髁置换术固定平台与活动平台假体对髌骨高度影像学变化的研究

Radiographic changes of patellar height with fixed-bearing versus mobile-bearing prosthesis in unicompartmental knee arthroplasty

目的基于X线图像对分别置入膝关节单髁固定平台假体与活动平台假体的患者进行术前与术后随访的测量,分析髌骨高度变化的差异。方法选取2021-09—2022-09因膝关节单侧间室骨性关节炎接受膝关节单髁置换术患者的影像资料进行测量分析,共纳入100例,根据置入假体类型将患者分为固定平台假体组(51例)与活动平台假体组(49例),行双下肢单髁置换者均置入相同假体。两组术前及术后采用Insall-Salvati(IS)和Caton-Deschamps(CD)比值测量髌骨高度并进行组间及组内比较。结果根据固定平台假体组及活动平台假体组组内亚组间分析结果,固定平台假体组中体质量指数亚组术后IS有明显差异(P<0.05),体质量指数≥28 kg/m^(2)亚组IS较高,其余亚组无明显差异(P>0.05)。活动平台假体组中性别亚组术前与术后IS有明显差异(P<0.05),女性亚组术前、术后IS均高于男性亚组;年龄亚组术前CD有明显差异(P<0.05),年龄<65岁亚组术前CD较高;体质量指数亚组术后CD有明显差异(P<0.05),体质量指数≥28 kg/m^(2)亚组术后CD较高。根据固定平台假体亚组与活动平台假体亚组组间分析结果,固定平台假体组男性、体质量指数<28 kg/m^(2)亚组术前IS高于活动平台假体组亚组(P<0.05),活动平台假体组年龄<65岁亚组术前CD高于固定平台假体组亚组(P<0.05),术后则无明显差异(P>0.05);其余测量参数对比无明显差异(P>0.05)。结论除固定平台假体组中男性及体质量指数<28 kg/m^(2)亚组术前IS明显高于活动平台假体组亚组外,无论年龄、性别、体质量指数及术式不同均未表现出两组之间存在明显差异。

Objective To analyze differences in patellar height changes based on X-ray imaging measurements on patients who received preoperative and postoperative follow-up with either fixed-bearing or mobile-bearing prosthesis implanted during unicompartmental knee arthroplasty.Methods Imaging data from patients with unilateral knee osteoarthritis who received unicompartmental knee arthroplasty from September 2021 to September 2022 were selected for measurement and analysis.A total of 100 cases were included,with patients categorized into two groups based on the type of implanted prosthesis:fixed-bearing group(51 cases)and mobile-bearing group(49 cases).Patients undergoing bilateral unicompartmental knee arthroplasty were all implanted with the same type of prosthesis.Patellar height was measured using the Insall-Salvati(IS)and Caton-Deschamps(CD)ratios before and after surgery,and inter-group and intra-group comparisons were conducted.Results According to the results of the inter-subgroup analysis within the fixed-bearing group and the mobile-bearing group,there was a significant difference in postoperative IS between the body mass index subgroups in the fixed-bearing group(P<0.05),and IS was higher in the subgroups with a body mass index of≥28 kg/m^(2),while there was no significant difference in the remaining subgroups(P>0.05).There was a significant difference between preoperative and postoperative IS in the gender subgroup of the mobilebearing group(P<0.05),with preoperative and postoperative IS in the female subgroup higher than that in the male subgroup;there was a significant difference in preoperative CD in the age subgroup(P<0.05),with preoperative CD being higher in the age<65 subgroup;and there was a significant difference in postoperative CD in the body mass index subgroup(P<0.05),with the subgroup with a body mass index≥28 kg/m^(2) had higher postoperative CD.Based on the results of the inter-subgroup analysis between the fixed-bearing subgroup and the mobile-bearing subgroup,the preoperative IS was higher in the fixed-bearing subgroup for males and the subgroup with a body mass index of<28 kg/m^(2) than in the mobile-bearing subgroup(P<0.05),and the preoperative CD was higher in the mobile-bearing subgroup for those<65 years of age than in the fixed-bearing subgroup(P<0.05);there were no significant differences in postoperative period(P>0.05);there was no significant difference in the comparison of the rest of the measured parameters(P>0.05).Conclusion The results of this study did not show any significant differences between the two groups in age,gender,body mass index,and surgery procedure,except that in the fixed-bearing group,the preoperative IS was significantly higher in males and in the subgroup with a body mass index of<28 kg/m^(2) compared with the subgroup in the mobile-bearing group.