活动平台单髁膝关节置换术中前切迹对髌股关节放射性示踪剂摄取及临床疗效的影响。
Influence of the anterior notch in mobile-bearing UKA on patellofemoral radiotracer uptake and clinical outcome.
作者信息
Dammerer Dietmar, Liebensteiner Michael, Rochau Hannes, Uprimny Christian, Smekal Vinzenz, Rosenberger Ralf, Servien Elvire
机构信息
Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, A - 6020, Innsbruck, Austria.
Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, A - 6020, Innsbruck, Austria.
出版信息
BMC Musculoskelet Disord. 2017 Dec 16;18(1):532. doi: 10.1186/s12891-017-1885-6.
BACKGROUND
Previous studies reported that in partial knee arthroplasty smooth transitions to the remaining native parts of the knee are important. However, in mobile-bearing unicondylar knee arthroplasty (UKA) it is mandatory to create an anterior osteochondral notch adjacent to the femoral component to get clearance for the anterior lip of the bearing in full knee extension. This notch is, however, part of the femoral trochlea. It was the aim of the study to test for a potential association between a) an obligatory anterior notch in mobile-bearing UKA located at the margin of the medial aspect of the femoral trochlea and b) postoperative patellofemoral joint (PFJ) bone remodelling and discomfort.
METHODS
In patients who underwent routine mobile-bearing UKA (11 male, 13 female; 64.5 years / IQR 14) the following parameters were prospectively determined i) size of the surgically created anterior notch, ii) knee score sensitive to PFJ disorders, iii) bone remodelling in the PFJ (radiotracer uptake in SPECT-CT).
RESULTS
Notch size was not correlated with radiotracer uptake at the PFJ. Similarly, no significant correlations were observed between radiotracer uptake (patella or trochleocondylar junction) and knee scores (KOOS or Kujala Score). Significant positive correlations were found between notch size and knee scores.
CONCLUSIONS
From the findings made in our study it is concluded that a larger size of the anterior notch in mobile-bearing medial Oxford UKA is not associated with increased osteochondral remodelling processes at the patella or the trochleocondylar junction. Neither is a larger sized notch associated with worse clinical PFJ outcome. Surprisingly, a larger notch was even associated with superior clinical outcome. The exact mechanism for this contraintuitive finding remains unclear but may be the basis for future research.
TRIAL REGISTRATION
The study is registered in a public trials registry. Link: (9/12/2017) ClinicalTrials.gov. NCT01407042 ; Date of registration: July, 26, 2011.
背景
既往研究报道，在部分膝关节置换术中，与膝关节其余天然部分实现平滑过渡很重要。然而，在活动平台单髁膝关节置换术（UKA）中，必须在股骨组件旁创建一个前骨软骨切迹，以便在膝关节完全伸直时为活动平台的前唇提供间隙。然而，这个切迹是股骨滑车的一部分。本研究的目的是测试a）活动平台UKA中位于股骨滑车内侧边缘的强制性前切迹与b）术后髌股关节（PFJ）骨重塑和不适之间是否存在潜在关联。
方法
在接受常规活动平台UKA的患者（11名男性，13名女性；平均年龄64.5岁/IQR 14）中，前瞻性地确定以下参数：i）手术创建的前切迹大小；ii）对PFJ疾病敏感的膝关节评分；iii）PFJ中的骨重塑（SPECT-CT中的放射性示踪剂摄取）。
结果
切迹大小与PFJ处的放射性示踪剂摄取无关。同样，在放射性示踪剂摄取（髌骨或滑车髁交界处）与膝关节评分（KOOS或库贾拉评分）之间未观察到显著相关性。切迹大小与膝关节评分之间存在显著正相关。
结论
根据我们的研究结果得出结论，活动平台内侧牛津UKA中较大尺寸的前切迹与髌骨或滑车髁交界处骨软骨重塑过程增加无关。较大尺寸的切迹也与较差的临床PFJ结果无关。令人惊讶的是，较大的切迹甚至与更好的临床结果相关。这一违反直觉发现的确切机制尚不清楚，但可能是未来研究的基础。
试验注册
该研究已在公共试验注册库中注册。链接：（2017年12月9日）ClinicalTrials.gov。NCT01407042；注册日期：2011年7月26日。
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