[1]马千里 郑玉云 吴敏瑞 刘 晖 陈 强.骨性关节炎38例膝内侧单髁置换术后的早中期疗效[J].福建医药杂志,2018,40(06):61-63.
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骨性关节炎38例膝内侧单髁置换术后的早中期疗效()
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《福建医药杂志》[ISSN:1002-2600/CN:35-1071/R]

卷:
40
期数:
2018年06期
页码:
61-63
栏目:
临床研究·
出版日期:
2018-11-29

文章信息/Info

文章编号:
1002-2600(2018)06-0061-04
作者:
马千里 郑玉云 吴敏瑞 刘 晖 陈 强
厦门大学附属福州第二医院骨科(福州 350007)
关键词:
膝关节 间室 骨性关节炎 单髁 早中期疗效
分类号:
R684.3
文献标志码:
B
摘要:
目的 评估膝内侧单髁置换术后的早中期疗效。 方法 对38例内侧膝关节骨性关节炎行单髁置换术(均为Ahlback 2级以上内侧间室膝关节炎,无膑股关节炎表现,保守治疗无效),采用牛津3代活动垫片型单髁假体,使用小创口手术入路,术前和最后的评估通过KSS评分系统。术后X线片评估采用牛津标准。平均随访时间24(18~32)个月。结果 术前平均膝关节屈曲度121.8(110~130)度,术后130.9(120~140)度(P<0.05)。膝关节伸直术前术后均无受限。平均术前和术后膝关节KSS评分分别是64.6(47~80)分和97.5(80~100)分,其中术前和术后的平均功能分分别是59.6(45~80)分和92.1(70~100)分。当患者功能分好时,膝关节综合评分(knee society score, KSS)也好,其中27例(71.1%)为极好,11例为好(28.9%)。术后X线片检查提示,所有患者股骨部件的位置均在可接受范围内,平均3度外翻(5度外翻到8度内翻),0.5度伸直(伸直3度到2度屈曲)。股骨部件的位置与机械轴的关系:30例在中心,8例侧移2 mm。所有患者胫骨部件的位置均在可接受范围,平均1.5度内翻(从内翻2度到外翻2度),平均后倾6.2(5~7)度。除一例有4 mm前侧移位外,余患者胫骨部件和平台前、后、内、外一致。所有患者聚乙烯内衬均在中心并平行于胫骨部件。未发现会导致膝关节撞击的骨赘和骨水泥碎片。随访到最后,所有部件均在位,无脱位、感染、肺栓塞、深部静脉血栓、神经血管损伤等并发症,无翻修。结论 只要选择合适手术指征,严格遵守外科操作,牛津3代活动垫片型单髁假体置换治疗膝关节内侧间室骨性关节炎的早中期疗效满意。

参考文献/References:

[1] Kleeblad L J, van der List J P, Zuiderbaan HA, et al. Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65: a systematic review[J]. Knee Surg Sports Traumatol Arthrosc,2018,26(6):1811-1822.
[2] Van der List J P, Kleeblad L J, Zuiderbaan H A, et al. Mid-term outcomes of metal-backed unicompartmental knee arthroplasty show superiority to all-polyethylene unicompartmental and total knee arthroplasty[J]. HSS J,2017,13(3):232-240.
[3] Koskinen E, Paavolainen P, Eskelinen A, et al. Unicondylar knee replacement for primary osteoarthritis: a prospective follow-up study of 1,819 patients from the finnish arthroplasty register[J]. Acta Orthop,2007,78(1):128-135.
[4] Price A J, Webb J, Topf H, et al. Rapid recovery after oxford unicompartmental arthroplasty through a short incision[J]. J Arthroplasty,2001,16(8):970-976.
[5] Insall J N, Dorr L D, Scott R D, et al. Rationale of the Knee Society clinical rating system[J]. Clin Orthop Relat Res,1989(248):13-14.
[6] Dammerer D, Liebensteiner M, Rochau H, et al. Influence of the anterior notch in mobile-bearing UKA on patellofemoral radiotracer uptake and clinical outcome[J]. BMC Musculoskelet Disord,2017,18(1):532.
[7] Pandit H, Jenkins C, Barker K, et al. The Oxford medial unicompartmental knee replacement using a minimally-invasive approach[J]. J Bone Joint Surg Br,2006,88(1):54-60.
[8] Kim K T, Lee S, Park H S, et al. A prospective analysis of Oxford phase 3 unicompartmental knee arthroplasty[J]. Orthopedics, 2007, 30(5 Suppl):15-18.
[9] Price A J, Dodd C A, Svard U G, et al. Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age[J]. J Bone Joint Surg, 2005,87(11):1488-1492.
[10] Carr A, Keyes G, Miller R O, et al. Medial unicompartmental arthroplasty. A survival study of the Oxford meniscal knee[J]. Clin Orthop Relat Res,1993,(295):205-213.
[11] White S H, Ludkowski P F, Goodfellow J W. Anteromedial osteoarthritis of the knee[J]. J Bone Joint Surg Br,1991,73(4):582-586.
[12] Kort N P, van Raay J J, van Horn J J. The Oxford phase Ⅲ unicompartmental knee replacement in patients less than 60 years of age[J]. Knee Surg Sports Traumatol Arthrosc, 2007,15(4):356-360.
[13] Streit M R, Streit J, Walker T, et al. Minimally invasive Oxford medial unicompartmental knee arthroplasty in young patients[J]. Knee Surg Sports Traumatol Arthrosc,2017,25(3):660-668.

更新日期/Last Update: 2018-11-29