Ji S J, Huang Y, Wang X S, Liu J, Dou Y, Jiang X, Zhou Y X
Department of Adult Joint Reconstruction Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2021 Mar 11;53(2):293-297. doi: 10.19723/j.issn.1671-167X.2021.02.010.
To analyze the preoperative influencing factors of varus after Oxford unicompartmental knee arthroplasty.
A total of 660 patients (767 knees) undergoing Oxford unicompartmental knee arthroplasty in adult joint reconstruction surgery department of Beijing Jishuitan Hospital from January 2018 to December 2019 were retrospectively analyzed. Inclusive criteria: diagnosis was osteoarthritis, single compartment lesions in the medial side of the knee; preoperative flexion deformity was less than 10°, active range of motion was greater than 90°; preoperative X-ray full-length images of both lower limbs showed less than 15° varus (Noyes method); anterior cruciate ligament was well functioned, The cartilage of lateral compartment of knee joint was intact.
combined with other inflammatory arthropathy; combined with extraarticular deformity; previous knee surgery history. The average age of the patients was (64.4±8.1) years, including 153 males and 497 females. The degree of post-operative varus was measured with Noyes method. The total patients were divided into varus group (Noyes≥3 °) and normal group (Noyes < 3 °). Gender, age, body mass index (BMI), range of motion (ROM), preoperative flexion deformity (FD), American Knee Society pain score (AKS) and American Knee Society function score (AKS function) were recorded. The standard anteroposterior and lateral X-ray films of knee joint and full-length lower extremity kinematic line films were taken by Sonialvision Safine Ⅱ (Shimadzu, Japan) multi-function digital tomography system. The image was measured by picture archiving and communication system (PACS). The following angles were measured preoperative Noyes angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and joint line converge angle (JLCA) were measured and analyzed.
Gender(=0.346), operative side (=0.619), age (=0.746), BMI (=0.142), preoperative ROM (=0.102), preoperative knee pain score (=0.131) and functional score (=0.098) were not risk factors for postoperative varus. The influencing factors of postoperative varus were preoperative MPTA < 84 ° (= 0.018, = 3.712, 95%: 1.250-11.027), preoperative Noyes > 5°(=0.000, = 3.105, 95%: 1.835-5.254), preoperative FD > 5° (= 0.001, =1.976, 95%: 1.326-3.234). Pre-operative LDFA (=0.146) and preoperative JLCA (= 0.709) had no significant effect on postoperative kinematic line.
Patients with severe preoperative varus, especially those with varus deformity mainly from the tibial side, and those with preoperative flexion deformity are more prone to get varus lower extremity kinematic line after Oxford unicompartmental knee arthroplasty.
分析牛津单髁膝关节置换术后内翻畸形的术前影响因素。
回顾性分析2018年1月至2019年12月在北京积水潭医院成人关节重建外科接受牛津单髁膝关节置换术的660例患者（767膝）。纳入标准：诊断为骨关节炎，膝关节内侧单髁病变；术前屈曲畸形小于10°，活动范围大于90°；术前双下肢X线全长片显示内翻小于15°（Noyes法）；前交叉韧带功能良好，膝关节外侧间室软骨完整。
合并其他炎性关节病；合并关节外畸形；既往膝关节手术史。患者平均年龄（64.4±8.1）岁，其中男性153例，女性497例。采用Noyes法测量术后内翻程度。将所有患者分为内翻组（Noyes≥3°）和正常组（Noyes<3°）。记录性别、年龄、体重指数（BMI）、活动范围（ROM）、术前屈曲畸形（FD）、美国膝关节协会疼痛评分（AKS）和美国膝关节协会功能评分（AKS功能）。采用日本岛津公司的Sonialvision SafineⅡ多功能数字断层扫描系统拍摄膝关节标准正侧位X线片及下肢全长运动学线片。图像通过图像存档与通信系统（PACS）进行测量。测量术前Noyes角、股骨远端外侧角（LDFA）、胫骨近端内侧角（MPTA）和关节线汇聚角（JLCA）并进行分析。
性别（=0.346）、手术侧别（=0.619）、年龄（=0.746）、BMI（=0.142）、术前ROM（=0.102）、术前膝关节疼痛评分（=0.131）和功能评分（=0.098）均不是术后内翻的危险因素。术后内翻的影响因素为术前MPTA<84°（=0.018，=3.712，95%：1.250-11.027）、术前Noyes>5°（=0.000，=3.105，95%：1.835-5.254）、术前FD>5°（=0.001，=1.976，95%：1.326-3.234）。术前LDFA（=0.146）和术前JLCA（=0.709）对术后运动学线无显著影响。
术前严重内翻的患者，尤其是主要来自胫骨侧的内翻畸形患者以及术前有屈曲畸形的患者，在牛津单髁膝关节置换术后更易出现下肢内翻运动学线。
