Yang Tao, Tu Yihui, Xue Huaming, Ma Tong, Wen Tao, Xue Long, Wang Fangxing, Meng Yu
Department of Adult Joint Reconstructive Surgery【？】, Yangpu Hospital, Shanghai Tongji University, Shanghai, 200090, P.R.China.
Department of Adult Joint Reconstructive Surgery【？】, Yangpu Hospital, Shanghai Tongji University, Shanghai, 200090,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Jan 15;33(1):8-12. doi: 10.7507/1002-1892.201808045.
To explore the imaging features of intramedullary guide rod and its influence on the alignment of the femoral prosthesis in unicompartmental knee arthroplasty (UKA).
Between August 2016 and November 2016, 50 patients (50 knees) with primary anteromedial osteoarthritis were treated with UKA by Oxford MicroPlasty minimally invasive replacement system. There were 10 males and 40 females. The age ranged from 62 to 77 years with an average of 68.8 years. Preoperative varus and flexion deformity angles were (5.22±3.46)° and (7.42±2.65)°, respectively. The knee range of motion (ROM) was (106.85±7.62)°. The Hospital for Special Surgery (HSS) score was 68.26±4.65. The angles between the femoral intramedullary guide rod and the anatomical axis of femur on the coronal and sagittal planes, the femoral component valgus/varus angle (FCVA), the femoral component posterior slope angle (FCPSA), knee varus deformity angle, and knee flexion deformity angle were measured by intra- and post-operative X-ray films. The postoperative ROM and HSS score were measured.
Intraoperative X-ray films measurement showed that the lateral side angles between femoral intramedullary guide rod and femoral anatomical axis were observed on coronal plane, and the angles ranged from 0.28 to 2.06° with an average of 0.96°. While the posterior side angles were observed on sagittal plane, and the angles ranged from 0.09 to 0.48° with an average of 0.23°. The angulations (>1°) between femoral intramedullary part guide rod and outside part of the rod were confirmed in 12 cases (24%) on coronal plane. Postoperative femoral prosthesis were mild varus in 38 patients (76%). The FCVA ranged from -1.76 to 4.08° with an average of 2.21°. The FCPSA ranged from 7.12 to 13.86° with an average of 9.16°. All patients were followed up 22-26 months, with an average of 24.5 months. The incisions healed by first intention. At last follow-up, the varus and flexion deformity angles were (1.82±1.05) and (2.54 ± 1.86)°, respectively. ROM was (124.62±5.85)° and HSS score was 91.58±3.65. There were significant differences between pre- and post-operative parameters ( <0.05). No complication such as dislocation or aseptic loosening of the prosthesis occurred during the follow-up.
UKA by Oxford MicroPlasty minimally invasive replacement system can obtain accurate femoral prosthesis position with the help of intramedullary guide system, and the effectiveness is excellent.
探讨单髁膝关节置换术（UKA）中髓内导杆的影像学特征及其对股骨假体对线的影响。
2016年8月至2016年11月，采用牛津微创置换系统对50例（50膝）原发性前内侧骨关节炎患者行UKA治疗。其中男性10例，女性40例。年龄62～77岁，平均68.8岁。术前内翻和屈曲畸形角度分别为（5.22±3.46）°和（7.42±2.65）°。膝关节活动范围（ROM）为（106.85±7.62）°。美国特种外科医院（HSS）评分为68.26±4.65。通过术中及术后X线片测量股骨髓内导杆与股骨解剖轴在冠状面和矢状面上的夹角、股骨假体外翻/内翻角（FCVA）、股骨假体后倾角（FCPSA）、膝关节内翻畸形角和膝关节屈曲畸形角。测量术后ROM和HSS评分。
术中X线片测量显示，股骨髓内导杆与股骨解剖轴在冠状面的外侧夹角为0.28～2.06°，平均0.96°。在矢状面观察后侧夹角，角度范围为0.09～0.48°，平均0.23°。12例（24%）在冠状面证实股骨髓内部分导杆与导杆外侧部分的夹角>1°。术后38例（76%）股骨假体呈轻度内翻。FCVA范围为-1.76～4.08°，平均2.21°。FCPSA范围为7.12～13.86°，平均9.16°。所有患者均随访22～26个月，平均24.5个月。切口一期愈合。末次随访时，内翻和屈曲畸形角度分别为（1.82±1.05）°和（2.54±1.86）°。ROM为（124.62±5.85）°，HSS评分为91.58±3.65。术前和术后参数比较差异有统计学意义（<0.05）。随访期间未发生假体脱位或无菌性松动等并发症。
牛津微创置换系统行UKA借助髓内导向系统可获得准确的股骨假体位置，效果良好。
