Steele R G, Hutabarat S, Evans R L, Ackroyd C E, Newman J H
The Winford Unit, Avon Orthopaedic Centre Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, UK.
J Bone Joint Surg Br. 2006 Sep;88(9):1164-8. doi: 10.1302/0301-620X.88B9.18044.
There have been several reports of good survivorship and excellent function at ten years with fixed-bearing unicompartmental knee replacement. However, little is known about survival beyond ten years. From the Bristol database of over 4000 knee replacements, we identified 203 St Georg Sled unicompartmental knee replacements (174 patients) which had already survived ten years. The mean age of the patients at surgery was 67.1 years (35.7 to 85) with 67 (38.5%) being under 65 years at the time of surgery. They were reviewed at a mean of 14.8 years (10 to 29.4) from surgery to determine survivorship and function. There were 99 knees followed up for 15 years, 21 for 20 years and four for 25 years. The remainder failed, were withdrawn, or the patient had died. In 58 patients (69 knees) the implant was in situ at the time of death. Revision was undertaken in 16 knees (7.9%) at a mean of 13 years (10.2 to 21.6) after operation. In seven knees (3.4%) this was for progression of arthritis, in three (1.5%) for wear of polyethylene, in four (2%) for tibial loosening, in two (1%) for fracture of the femoral component and in two (1%) for infection. Two knees (1%) were revised for more than one reason. The mean Bristol knee score of the surviving knees fell from 86 (34 to 100) to 79 (42 to 100) during the second decade. Survivorship to 20 years was 85.9% (95% CI 82.9% to 88.9%) and at 25 years was 80% (95% CI 70.2% to 89.8%). Satisfactory survival of a fixed-bearing unicompartmental knee replacement can be achieved into the second decade and beyond.
已有多篇报道称，采用固定平台单髁膝关节置换术，患者十年生存率良好且功能优异。然而，对于十年后的生存率情况却知之甚少。我们从布里斯托尔超过4000例膝关节置换手术的数据库中，识别出203例已存活十年的圣乔治雪橇式单髁膝关节置换术（涉及174名患者）。手术时患者的平均年龄为67.1岁（35.7至85岁），其中67例（38.5%）手术时年龄在65岁以下。从手术到平均14.8年（10至29.4年）期间对他们进行复查，以确定生存率和功能情况。有99例膝关节随访了15年，21例随访了20年，4例随访了25年。其余的膝关节置换失败、被撤回，或者患者已死亡。58例患者（69个膝关节）在死亡时植入物仍在位。术后平均13年（10.2至21.6年）时，16个膝关节（7.9%）进行了翻修。其中7个膝关节（3.4%）是因为关节炎进展，3个（1.5%）是因为聚乙烯磨损，4个（2%）是因为胫骨松动，2个（1%）是因为股骨部件骨折，2个（1%）是因为感染。2个膝关节（1%）因多种原因进行了翻修。在第二个十年期间，存活膝关节的布里斯托尔膝关节平均评分从86分（34至100分）降至79分（42至100分）。20年生存率为85.9%（95%可信区间82.9%至88.9%），25年生存率为80%（95%可信区间70.2%至89.8%）。固定平台单髁膝关节置换术在第二个十年及以后能实现令人满意的生存率。
