活动平台与固定平台假体膝单髁置换术早期临床疗效比较

Comparison of early clinical outcomes between mobile-bearing and fixed-bearing prostheses in unicompartmental knee arthroplasty

目的:比较活动平台(MB)和固定平台(FB)假体在膝单髁置换术(UKA)治疗膝内侧间室骨关节炎(OA)患者的早期临床疗效。方法:回顾性分析2021年5月至2022年12月山东省文登整骨医院收治的因膝内侧间室OA行UKA患者的临床资料,共346例(373膝),其中MB组149例(157膝)、FB组197例(216膝)。比较两组患者末次随访时膝关节活动度(ROM)、疼痛视觉模拟评分(VAS)、牛津大学膝关节评分(OKS)、美国特种外科医院膝关节评分(HSS)、关节遗忘评分(FJS);通过影像学检查测量股胫角(FTA)、胫骨假体内外翻角(TCVA)、胫骨假体后倾角(TCPSA);记录患者术后并发症发生情况及假体生存率。结果:两组患者末次随访时ROM、VAS、HSS比较,差异均无统计学意义(P均>0.05);FJS、OKS比较差异均有统计学意义(P均<0.05)。两组患者末次随访时TCVA、TCPSA比较,差异均无统计学意义(P均>0.05);FTA比较差异有统计学意义(P=0.001)。MB组和FB组患者的并发症总发生率为6.7%(10/149)和8.4%(15/197),差异无统计学意义(P=0.827)。MB组翻修4例,UKA假体生存率为97.45%(153/157);FB组无一例患者进行翻修,UKA假体生存率为100%(216/216)(P=0.031)。结论:MB与FB假体UKA术后早期均可获得良好的膝关节功能及影像学评价。MB假体能够使患者获得更好的膝关节自我感受,更有利于矫正膝关节内翻畸形,但脱位风险较高;FB假体能够获得更高的假体生存率。

Objective:To compare the early clinical outcomes of mobile-bearing(MB) and fixed-bearing(FB) prostheses in unicompartmental knee arthroplasty(UKA) for patients with medial compartment knee osteoarthritis(OA).Methods:A retrospective study was conducted on the clinical data of patients with medial compartment knee OA who underwent UKA at Wendeng Osteopathic Hospital from May 2021 to December 2022.A total of 346 cases(373 knee joints) were included,with 149 cases(157 knee joints) in the MB group and 197 cases(216 knee joints) in the FB group.The outcomes including postoperative knee range of motion(ROM),visual analog scale(VAS) score,Oxford knee score(OKS),Hospital for Special Surgery score(HSS),and forgotten joint score(FJS) were compared between the two groups.Radiographic measurements included the femorotibial angle(FTA),tibial component varus/valgus angle(TCVA),and tibial component posterior slope angle(TCPSA).Postoperative complications and prosthetic survival rates were also recorded.Results:There were no statistically significant differences in ROM,VAS or HSS between the two groups at the final followup(all P>0.05).However,FJS and OKS were significantly different(all P<0.05).There were no statistically significant differences in the TCVA or TCPSA at the final follow-up(all P>0.05),but FTA differed significantly(P=0.001).Postoperative complications occurred in 6.7%(10/149) of the MB group and 8.4%(15/197) of the FB group,with no significant difference(P=0.827).Four cases in the MB group required revision,with a UKA prosthetic survival rate of 97.45%(153/157),whereas no revisions occurred in the FB group,yielding a survival rate of 100%(216/216)(P=0.031).Conclusions:Both MB and FB prostheses can achieve satisfactory knee joint function and radiographic outcomes in the early postoperative period after UKA.MB prostheses are associated with better patient selfperception of the knee and greater effectiveness in correcting varus deformities but have a higher risk of dislocation.Moreover,FB prostheses result in a higher prosthetic survival rate.