Ackroyd C E
Avon Orthopaedic Centre, Bristol, England.
J Bone Joint Surg Br. 2003 Sep;85(7):937-42. doi: 10.1302/0301-620x.85b7.14650.
Compartmental arthritis forms a significant subgroup of patients presenting with osteoarthritis of the knee. Involvement of the medial compartment is the most common and can be successfully treated by unicompartmetal arthroplasty. The first step is to obtain an accurate diagnosis of the process of the disease, and, particularly, to evaluate the integrity of the ACL. Assessment requires clinical, radiographic and perhaps arthroscopic evaluation, but the final decision will depend upon judgement taken at the time of the arthrotomy. This improves with experience and it is essential that the surgeon has sufficient basic understanding and regular practice. The decision on the design of the prosthesis is critical. This should be based on ten-year survivorship studies with a success rate of at least 85% to 90%. The technically more demanding prostheses can give excellent long-term results in some centres. The less complex prostheses can produce good long-term results in more general use. Most studies consistently report lower complication rates, more rapid recovery and long-term results of better quality than TKR. Set against this must be the recognition that failure because of progression of the disease can occur in addition to that due to mechanical causes. There is no convincing evidence that the well-tried and tested prostheses have a significantly greater overall rate of failure than TKR. Reports of revision show that this is not technically demanding and is considerably simpler than for failed TKR with results which are probably little different from those of a primary arthroplasty. The resurgent interest in compartmental arthroplasty is based on encouraging reports from those few centres which have pioneered the treatment. Successful results require a detailed knowledge of the pathology, indications, technique and management of the procedure. This philosophy adds several extra dimensions to the routine of established knee arthroplasty.
单间室关节炎是膝关节骨关节炎患者中的一个重要亚组。内侧间室受累最为常见，可通过单髁关节置换术成功治疗。第一步是准确诊断疾病进程，尤其是评估前交叉韧带的完整性。评估需要临床、影像学检查，可能还需要关节镜检查，但最终决定将取决于关节切开时的判断。这会随着经验的积累而改善，外科医生必须有足够的基本理解并定期实践。假体设计的决定至关重要。这应基于十年生存率研究，成功率至少为85%至90%。技术要求较高的假体在一些中心可取得出色的长期效果。较简单的假体在更广泛的应用中也能产生良好的长期效果。大多数研究一致报告，与全膝关节置换术相比，其并发症发生率更低、恢复更快且长期效果质量更好。但必须认识到，除了机械原因导致的失败外，疾病进展也可能导致失败。没有令人信服的证据表明，久经考验的假体总体失败率比全膝关节置换术显著更高。翻修报告表明，这在技术上要求不高，比失败的全膝关节置换术简单得多，结果可能与初次关节置换术相差不大。对单间室关节置换术重新燃起的兴趣基于少数率先开展该治疗的中心的鼓舞人心的报告。成功的结果需要对该手术的病理、适应症、技术和管理有详细的了解。这种理念为既定的膝关节置换术常规增加了几个额外的维度。
