Kendrick B J L, Rout R, Bottomley N J, Pandit H, Gill H S, Price A J, Dodd C A F, Murray D W
Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK.
J Bone Joint Surg Br. 2010 Mar;92(3):374-9. doi: 10.1302/0301-620X.92B3.23561.
With medial unicompartmental osteoarthritis (OA) there is occasionally a full-thickness ulcer of the cartilage on the medial side of the lateral femoral condyle. It is not clear whether this should be considered a contraindication to unicompartmental knee replacement (UKR). The aim of this study was to determine why these ulcers occur, and whether they compromise the outcome of UKR. Case studies of knees with medial OA suggest that cartilage lesions on the medial side of the lateral condyle are caused by impingement on the lateral tibial spine as a result of the varus deformity and tibial subluxation. Following UKR the varus and the subluxation are corrected, so that impingement is prevented and the damaged part of the lateral femoral condyle is not transmitting load. An illustrative case report is presented. Out of 769 knees with OA of the medial compartment treated with the Oxford UKR, 59 (7.7%) had partial-thickness cartilage loss and 20 (2.6%) had a full-thickness cartilage deficit on the medial side of the lateral condyle. The mean Oxford Knee Score (OKS) at the last follow-up at a mean of four years was 41.9 (13 to 48) in those with partial-thickness cartilage loss and 41.0 (20 to 48) in those with full-thickness loss. In those with normal or superficially damaged cartilage the mean was 39.5 (5 to 48) and 39.7 (8 to 48), respectively. There were no statistically significant differences between the pre-operative OKS, the final review OKS or of change in the score in the various groups. We conclude that in medial compartment OA, damage to the medial side of the lateral femoral condyle is caused by impingement on the tibial spine and should not be considered a contraindication to an Oxford UKR, even if there is extensive full-thickness ulceration of the cartilage.
对于内侧单髁骨关节炎（OA），外侧股骨髁内侧偶尔会出现软骨全层溃疡。目前尚不清楚这是否应被视为单髁膝关节置换术（UKR）的禁忌症。本研究的目的是确定这些溃疡发生的原因，以及它们是否会影响UKR的手术效果。内侧OA膝关节的病例研究表明，外侧髁内侧的软骨损伤是由于内翻畸形和胫骨半脱位导致外侧胫骨棘受到撞击所致。UKR术后，内翻和半脱位得到纠正，从而防止了撞击，外侧股骨髁受损部分不再承受负荷。本文给出了一个典型病例报告。在接受牛津UKR治疗的769例内侧间室OA膝关节中，59例（7.7%）外侧髁内侧有软骨部分厚度缺失，20例（2.6%）有软骨全层缺损。软骨部分厚度缺失患者在平均4年的最后一次随访时，牛津膝关节评分（OKS）平均为41.9（13至48），软骨全层缺失患者为41.0（20至48）。软骨正常或轻度受损患者的平均评分分别为39.5（5至48）和39.7（8至48）。各组术前OKS、最终复查OKS或评分变化之间无统计学显著差异。我们得出结论，在内侧间室OA中，外侧股骨髁内侧的损伤是由胫骨棘撞击引起的，即使存在广泛的软骨全层溃疡，也不应被视为牛津UKR的禁忌症。
