Sah Alexander P, Scott Richard D
Rush University Medical Center, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612, USA.
J Bone Joint Surg Am. 2008 Oct;90 Suppl 2 Pt 2:195-205. doi: 10.2106/JBJS.H.00257.
Unicompartmental knee arthroplasty of the medial compartment has excellent long-term clinical outcomes. Arthritis isolated to the lateral compartment is much less common; subsequently, the clinical outcomes of the treatment of that condition are less frequently reported. Most commonly, the lateral compartment is approached through a lateral arthrotomy. The purpose of this study was to determine the midterm results of lateral unicondylar replacement through a medial arthrotomy in patients with primary osteoarthritis or posttraumatic arthritis.
From 1991 to 2004, forty-nine lateral unicompartmental knee arthroplasties were performed in forty-five patients by a single surgeon. One patient was excluded from the study because of a severe underlying neurologic condition. Lateral unicompartmental replacement was performed in thirty-eight knees with primary osteoarthritis and in ten knees with posttraumatic arthritis secondary to a tibial plateau fracture. Retrospective chart reviews and radiographic evaluations were performed, and Knee Society scores were determined.
The average Knee Society knee and function scores improved from 39 and 45 points, respectively, preoperatively to 89 and 80 points at an average of 5.2 years postoperatively. Preoperative alignment averaged 10 degrees of valgus, which was corrected to an average of 6.2 degrees of valgus postoperatively. There were no revisions and no notable soft-tissue complications. The mean postoperative knee and function scores were significantly better for patients with primary osteoarthritis (95 and 86 points, respectively) than they were for those with posttraumatic arthritis (74 and 65 points).
Lateral unicompartmental knee replacement through a medial approach provided durable and reliable short to midterm results. This approach is safe, effective, and extensile, making it a viable alternative to a lateral approach. The outcomes of lateral unicompartmental replacement in patients with posttraumatic arthritis can be expected to be inferior to those in patients with primary osteoarthritis.
内侧单髁膝关节置换术具有出色的长期临床疗效。单纯外侧间室关节炎则较为少见；因此，针对该病症治疗的临床疗效报告也较少。最常用的方法是通过外侧关节切开术显露外侧间室。本研究的目的是确定采用内侧关节切开术对原发性骨关节炎或创伤后关节炎患者进行外侧单髁置换的中期结果。
1991年至2004年，由同一位外科医生对45例患者实施了49例外侧单髁膝关节置换术。1例患者因存在严重的基础神经疾病被排除在研究之外。对38例原发性骨关节炎膝关节和10例继发于胫骨平台骨折的创伤后关节炎膝关节进行了外侧单髁置换。进行了回顾性病历审查和影像学评估，并确定了膝关节协会评分。
膝关节协会的膝关节评分和功能评分平均从术前的39分和45分分别提高到术后平均5.2年时的89分和80分。术前平均外翻角度为10度，术后平均矫正至外翻6.2度。没有进行翻修手术，也没有明显的软组织并发症。原发性骨关节炎患者术后膝关节评分和功能评分的平均值（分别为95分和86分）明显高于创伤后关节炎患者（分别为74分和65分）。
经内侧入路的外侧单髁膝关节置换术提供了持久且可靠的短期至中期结果。这种方法安全有效且具有扩展性，是外侧入路的可行替代方案。创伤后关节炎患者外侧单髁置换的疗效预计低于原发性骨关节炎患者。
