Department of Orthopaedic Surgery, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical College, Beijing 100029, China.
Graduate School, Beijing University of Chinese Medicine, Beijing 100029, China.
Chin Med J (Engl). 2019 Nov 20;132(22):2690-2697. doi: 10.1097/CM9.0000000000000494.
Previously, the authors modified the surgical technique to preserve tibial bone mass for Oxford unicompartmental knee arthroplasty (UKA). The purpose of this study was to determine the clinical outcomes and values of this modified technique.
Clinical data of 34 consecutive patients who underwent the unilateral modified UKA technique (modified group, 34 knees) were retrospectively analyzed. To compare the outcome, a match-paired control group (conventional group, 34 knees) of an equal number of patients using the conventional technique system in the same period were selected and matched with respect to diagnosis, age, pre-operative range of motion (ROM), and radiological grade of knee arthrosis. Clinical outcomes including knee Hospital for Special Surgery (HSS) score, ROM, and complications were compared between the two groups. Post-operative radiographic assessments included hip-knee-ankle angle (HKA), joint line change, implant position, and alignment.
The mean follow-up time was 38.2 ± 6.3 months. There was no difference in baseline between the two groups. The amount of proximal tibial bone cut in the modified group was significantly less than that of the conventional group (4.7 ± 1.1 mm vs. 6.7 ± 1.3 mm, t = 6.45, P < 0.001). Joint line was elevated by 2.1 ± 1.0 mm in the modified group compared with -0.5 ± 1.7 mm in the conventional group (t = -7.46, P < 0.001). No significant differences were observed between the two groups after UKA with respect to HSS score, VAS score, ROM, and HKA. Additionally, the accuracy of the post-operative implant position and alignment was similar in both groups. As for implant size, the tibial implant size in the modified group was larger than that in the conventional group (χ = 4.95, P = 0.035).
The modified technique for tibial bone sparing was comparable with the conventional technique in terms of clinical outcomes and radiographic assessments. It can preserve tibial bone mass and achieve a larger cement surface on the tibial side.
此前，作者对手术技术进行了改良，以保留牛津单髁膝关节置换术（UKA）的胫骨骨量。本研究的目的是确定该改良技术的临床结果和价值。
回顾性分析了 34 例连续单侧改良 UKA 技术患者的临床资料（改良组，34 膝）。为了比较结果，选择了同期使用常规技术系统的 34 例患者的配对对照组（常规组），并在诊断、年龄、术前活动范围（ROM）和膝关节骨关节炎放射学分级方面进行了匹配。比较两组的临床结果，包括膝关节特殊外科医院（HSS）评分、ROM 和并发症。术后影像学评估包括髋膝踝角（HKA）、关节线变化、植入物位置和对线。
平均随访时间为 38.2±6.3 个月。两组基线无差异。改良组胫骨近端骨切量明显少于常规组（4.7±1.1mm 比 6.7±1.3mm，t=6.45，P<0.001）。改良组关节线抬高 2.1±1.0mm，常规组降低 0.5±1.7mm（t=-7.46，P<0.001）。UKA 后，两组在 HSS 评分、VAS 评分、ROM 和 HKA 方面均无显著差异。此外，两组术后植入物位置和对线的准确性相似。对于植入物尺寸，改良组胫骨植入物尺寸大于常规组（χ=4.95，P=0.035）。
在临床结果和影像学评估方面，胫骨骨量保留改良技术与常规技术相当。它可以保留胫骨骨量，并在胫骨侧获得更大的水泥表面。
