单髁关节置换术的近期疗效分析

Early clinical effects of unicompartmental knee arthroplasty

目的探讨单髁关节置换术(UKA)在膝骨关节炎中的运用和疗效。方法选取2007年4月至2013年8月在济南军区总医院骨病科行单髁关节置换术的161例患者(共182膝),其中男41例,女120例;年龄40~82岁,平均年龄63.4岁;体重58.3~73.9 kg,平均体重65.1 kg。术前行膝关节负重正侧位、双下肢全长正位及髌骨轴位X线片检查。测量术前术后膝关节活动度,采用视觉模拟评分(VAS)、美国膝关节协会评分(KSS)及膝关节活动度评分等指标对膝关节进行评估与分析。结果其中141例(共160膝)患者获得良好随访,无感染、深静脉血栓形成,2例患者术后发生衬垫脱位;1例股骨髁假体松动并衬垫脱位;1例股骨髁假体位置异常,术后反复出现关节绞锁,后行切开探查调整股骨髁假体后恢复正常。随访时间3~60个月,平均2年。KSS评分术前为(60.5±2.7)分,术后为(93.1±1.1)分,手术前后的KSS评分差异有统计学意义(P<0.05);VAS评分术前为(6.7±1.1)分,术后为(2.6±0.9)分,手术前后的VAS评分差异有统计学意义(P<0.05);膝关节屈曲度术前平均(100.3±2.6)°,术后平均(127.5±3.2)°,手术前后的差异有统计学意义(P<0.05)。结论在治疗膝内侧间室骨关节炎上,UKA是一种创伤小、恢复快及疗效显著的治疗方法,但中远期疗效有待进一步的随访和研究。

Objective To explore the application and clinical effects of unicompartmen talknee arthroplasty ( UKA) in the treatment of osteoarthritis.Methods From 2007.4 to 2013.8, 161 patients (182 knees) with medial compartment osteoarthritis were treated by UKA in department of orthopedics, General Hospital of Jinan military area, consisting of 41 males,120 females, mean age 63.4 years ( range 40-82 years ) , mean weight 65.1 kg ( range 58.3 -73.9 kg ) . The preoperative X-ray included anteroposterior and lateral images of the knee joint, full-length image of the lower limb, and the patella-axial view.The preoperative and postoperative knee activity tests, American knee society knee score ( KSS) and visual analog score ( VAS) of knee joint were evaluated and analyzed.Results All the cases were followed up for 3-60 months ( two years in average ) .No infection or deep venous thrombosis was observed;two cases developed dislocation of the prosthesis bearing;one case developed femoral condylar prosthesis loosening and dislocation of the prosthesis bearing;one case developed malposition of the femoral condylar prosthesis.As for the preoperative data and the postoperative data, the differences in joint flexion ability[preoperative (100.3 ±2.6)°vs postoperative (127.5 ±3.2)°,P<0.05], KSS score[preoperative (60.5 ±2.7)vs (93.1 ±1.1) at last follow-up,P<0.05)] and VAS score[(preoperative (6.7 ±1.1) vs ( 2.6 ±0.9 ) at last follow-up, P <0.05 ) ] were significant.Conclusion In the treatment of medial compartment osteoarthritis, UKA has advantages such as less trauma, fewer complications and rapid recovery,but its mid and long term efficacy still needs further follow-up and research.