中国一家骨科中心晚期膝关节骨关节炎的受累间室模式：对植入物选择的启示
Patterns of Compartment Involvement in End-stage Knee Osteoarthritis in a Chinese Orthopedic Center: Implications for Implant Choice.
作者信息
Wang Wei-Jun, Sun Ming-Hui, Palmer Jonathan, Liu Fei, Bottomley Nicholas, Jackson William, Qiu Yong, Weng Wen-Jie, Price Andrew
机构信息
Department of Orthopaedics, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK.
出版信息
Orthop Surg. 2018 Aug;10(3):227-234. doi: 10.1111/os.12395.
OBJECTIVES
Knee osteoarthritis (OA) is a prevalent disease in the elderly, causing pain and contributing to poor quality of life. Surgical intervention, such as knee arthroplasty, can be used in those with end-stage knee OA. Total knee arthroplasty (TKA) is one of the most common surgical procedures for end-stage knee OA, with promising clinical outcomes. However, a large proportion of patients with isolated compartment OA can be treated with unicompartmental knee arthroplasty (UKA) instead. UKA has shown better patient-reported functional outcomes, and lower mortality and major complication rates than TKA. The percentage of UKA in knee arthroplasty varied in different orthopedic centers, and we believed that the requirement for UKA was underestimated in many centers. A retrospective study was carried out on our Chinese patient population presenting for knee arthroplasty; it aimed to identify the proportion of patients that might be suitable for UKA.
METHODS
A retrospective cross-sectional study of 155 consecutive patients (168 knees) awaiting TKA for end-stage primary OA was performed. The pattern and grade of OA was recorded from preoperative weight-bearing anteroposterior and non-weight-bearing lateral radiographs. The medial, lateral, patellofemoral compartment was given an individual Kellgren-Lawrence grade on the radiographs, and those grade ≥3 were defined as end-stage OA. The compartments involvement was established then. The integrity of the anterior cruciate ligament (ACL) was determined by the modified Keyes classification on lateral radiographs. The applicability for total or partial knee arthroplasty was determined according to the compartments involvement.
RESULTS
Medial compartment involvement was found in 154 (91.7%) knees, while the involvement of the lateral compartment and patellofemoral joint was found in 54 (32.1%) and 57 (33.9%) knees, respectively. Eighty-one (48.2%) of the knees showed medial compartment OA with or without patellofemoral joint involvement, and modified Keyes classification grade 1, indicating an intact ACL, and, hence, potential suitability for medial UKA. Isolated lateral OA indicating possible suitability for lateral UKA was identified in 11 knees (6.5%). No patients showed isolated patellofemoral joint OA. The other 76 (45.2%) knees could be treated by TKA.
CONCLUSIONS
The medial compartment was the most commonly affected in our Chinese patients indicated for knee arthroplasty. More than half of the patients in this group could be treated by either medial or lateral UKA.
目的
膝关节骨关节炎（OA）是老年人中的一种常见疾病，会引起疼痛并导致生活质量下降。手术干预，如膝关节置换术，可用于终末期膝关节OA患者。全膝关节置换术（TKA）是治疗终末期膝关节OA最常见的外科手术之一，临床效果良好。然而，相当一部分单纯间室OA患者可用单髁膝关节置换术（UKA）治疗。与TKA相比，UKA在患者报告的功能结局方面表现更好，死亡率和主要并发症发生率更低。UKA在膝关节置换术中的占比在不同骨科中心有所不同，我们认为许多中心对UKA的需求被低估了。对我院行膝关节置换术的中国患者群体进行了一项回顾性研究；旨在确定可能适合UKA的患者比例。
方法
对155例（168膝）因终末期原发性OA等待TKA的连续患者进行回顾性横断面研究。术前负重前后位和非负重侧位X线片记录OA的类型和分级。在X线片上，分别对内侧、外侧、髌股间室给予Kellgren-Lawrence分级，分级≥3级定义为终末期OA。然后确定间室受累情况。根据改良的Keyes分类法在侧位X线片上确定前交叉韧带（ACL）的完整性。根据间室受累情况确定全膝关节置换术或部分膝关节置换术的适用性。
结果
154膝（91.7%）存在内侧间室受累，54膝（32.1%）存在外侧间室受累，57膝（33.9%）存在髌股关节受累。81膝（48.2%）表现为内侧间室OA，伴或不伴髌股关节受累，改良Keyes分类为1级，表明ACL完整，因此可能适合内侧UKA治疗。11膝（6.5%）为单纯外侧OA，提示可能适合外侧UKA治疗。无患者表现为单纯髌股关节OA。其余76膝（45.2%）可行TKA治疗。
结论
在我院行膝关节置换术的中国患者中，内侧间室受累最为常见。该组中超过一半的患者可采用内侧或外侧UKA治疗。
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