固定平台单髁置换中胫股假体对位对早期临床效果的影响

Effect of component alignment on short-term clinical outcomes in medial fixed-bearing unicompartmental knee arthroplasty

目的探究采用固定平台单髁置换术(FB-UKA)治疗膝关节前内侧骨关节炎(AMOA)术后胫股假体对位情况对早期临床效果的影响。方法回顾性分析自2021年1月至2023年1月于苏州市立医院关节外科接受FB-UKA治疗单侧膝关节AMOA的133例(133膝)患者的相关资料,术后依据影像学资料测量胫股假体冠状位角、矢状位股骨假体屈伸角和胫骨假体后倾角、胫股假体轴位角,排除其他角度差异后,依据胫股假体冠状位角将患者分为<0°组、0°~6°组、>6°组3组。术后随访时采用牛津膝关节评分(OKS)、膝关节协会评分(KSS)、关节遗忘评分(FJS)、膝关节活动度(ROM)评估膝关节功能并记录并发症发生情况,比较患者术后临床结果差异。结果<0°组、0°~6°组、>6°组分别纳入4例、72例、57例患者,平均随访(18.7±5.7)个月。术后3组患者的OKS评分、KSS评分及膝关节ROM均优于术前(P<0.05)。OKS评分、KSS临床评分和FJS评分方面,末次随访时0°~6°组患者显著优于>6°组(P<0.05)。KSS功能评分和膝关节ROM方面,术后0°~6°、>6°两组患者比较差异无统计学意义(P>0.05)。并发症方面,0°~6°组患者术后膝关节不明原因疼痛的发生率显著低于>6°组(P<0.05),0°~6°组、>6°组患者一般并发症、假体相关并发症发生率比较,差异无统计学意义(P>0.05)。<0°组因病例数过少,未与0°~6°组、>6°组进行比较。结论采用FB-UKA治疗膝关节AMOA术后可获得良好的临床结果,且冠状位胫股假体对位情况与术后临床结果密切相关,当冠状位股骨假体相对于胫骨假体轻度外翻(0°~6°)时,术后可能获得较好的临床结果。

Objective To explore the effect of component alignment on short-term clinical outcomes in fixed-bearing unicompartmental knee arthroplasty(FB-UKA)for the treatment of antero medial osteoarthritis(AMOA)of the knee.Methods A retrospective study was done on 133 patients(133 knees)who underwent FB-UKA for AMOA from January 2021 to January 2023 in Department of Orthopedics of Suzhou Municipal Hospital.Coronal angle of tibiofemoral component,flexion and extension angle of femoral component,posterior inclination angle of tibial component and axial angle of tibiofemoral component were measured by imaging data.After excluding the influence of the other three angles,patients were divided into three groups according to the coronal angle of tibiofemoral component:group<0°,group 0°~6°and group>6°.The oxford knee score(OKS),knee society score(KSS),forgotten joint score(FJS)and range of knee motion(ROM)were used to evaluate knee function during postoperative follow-up.The occurrence of complications was recorded and the difference of short-term clinical outcomes was compared.Results There were 4 patients in group<0°,72 patients in group 0°~6°and 57 patients in group>6°.All patients were followed up for(18.7±5.7)months.The postoperative OKS,KSS and knee ROM of patients were all better than those before surgery(P<0.05).In terms of OKS,KSS clinical score and FJS,patients in group 0°~6°were significantly better than those in group>6°at the last follow-up(P<0.05).There was no significant difference in KSS function score and knee ROM between group 0°~6°and group>6°at the last follow-up(P>0.05).In terms of complications,the incidence of postoperative unexplained knee pain in group 0°~6°was significantly lower than that in group>6°(P<0.05),and there was no significant difference in the incidence of general complications and component related complications between group 0°~6°and group>6°(P>0.05).Considering that only 4 patients were assigned to group<0°,data in group<0°were not compared with the other two groups due to the small sample size.Conclusion Satisfactory short-term clinical outcomes can be achieved in the treatment of AMOA with FB-UKA.The coronal alignment of tibiofemoral component is closely related to postoperative clinical outcomes,and when the coronal angle of tibiofemoral component is 0°~6°,better short-term clinical outcomes may be achieved after surgery.