Daniilidis K, Skwara A, Skuginna A, Fischer F, Tibesku C O
Klinik und Poliklinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum Münster.
Z Orthop Unfall. 2009 Mar-Apr;147(2):188-93. doi: 10.1055/s-0029-1185528. Epub 2009 Apr 8.
Cementation of tibial implants in total knee arthroplasty is the gold standard considering the high loosening rates of cementless implants. In contrast, only sparse data exist regarding unicondylar arthroplasty due to its lesser use. In this study, we compare cemented with cementless unicondylar knee arthroplasty and aim to define both clinical and radiological differences in treatment outcome.
In a retrospective study, 106 patients who had undergone a medial unicondylar replacement were examined after a mean postoperative period of 8 years. Of these, 42 patients (median age 81 +/- 7 years) had received a cemented and 64 (median age 73 +/- 7 years) a cementless knee arthroplasty by the same surgeon while 7 patients were deceased or could not be reached. Well-established clinical (VAS, HSS, KSS, UCLA, WOMAC) and quality of life (SF-36) scores were used to evaluate treatment outcome. X-rays were performed to evaluate periprosthetic loosening zones, according to Ewald's criteria.
The cementless patient group presented significantly better clinical scores (HSS, KSS, UCLA, WOMAC), except in the visual analogue scale (VAS) for pain assessment. The quality of life was significantly better in the cementless group except in the subgroups for physical function, vitality and social role, in that it resembles the normal population. Moreover, radiographic analysis using antero-posterior X-rays revealed significantly more and larger periprosthetic loosening areas in tibial zone 2 in the cementless group.
The inferior clinical results characterising the cemented group could be attributed to the higher mean age. Regarding the radiological loosening zones, we did not detect any differences in the techniques of fixation, although physical activity and accordingly mechanical stresses were higher in the cementless group.
考虑到非骨水泥型植入物的高松动率，全膝关节置换术中胫骨植入物的骨水泥固定是金标准。相比之下，由于单髁置换术使用较少，关于它的数据很少。在本研究中，我们比较骨水泥型与非骨水泥型单髁膝关节置换术，并旨在确定治疗结果在临床和影像学上的差异。
在一项回顾性研究中，对106例行内侧单髁置换术的患者进行了检查，术后平均随访8年。其中，42例患者（中位年龄81±7岁）接受了由同一位外科医生进行的骨水泥型膝关节置换术，64例患者（中位年龄73±7岁）接受了非骨水泥型膝关节置换术，另有7例患者死亡或无法联系到。采用成熟的临床评分（视觉模拟评分法[VAS]、美国特种外科医院[HSS]评分、膝关节协会[KSS]评分、加州大学洛杉矶分校[UCLA]评分、西方安大略和麦克马斯特大学骨关节炎指数[WOMAC]）和生活质量评分（健康调查简表[SF-36]）来评估治疗结果。根据埃瓦尔德标准进行X线检查，以评估假体周围松动区域。
除疼痛评估的视觉模拟评分法（VAS）外，非骨水泥型患者组的临床评分（HSS、KSS、UCLA、WOMAC）明显更好。非骨水泥型组的生活质量明显更好，除了身体功能、活力和社会角色亚组，其生活质量与正常人群相似。此外，使用前后位X线片进行的影像学分析显示，非骨水泥型组胫骨2区的假体周围松动区域明显更多、更大。
骨水泥型组较差的临床结果可能归因于其较高的平均年龄。关于影像学松动区域，尽管非骨水泥型组的体力活动和相应的机械应力较高，但我们未发现固定技术上的任何差异。
