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牛津单髁膝关节置换术治疗内侧间室骨关节炎的长期随访结果:单中心10年经验

[Long-term outcome follow-up of Oxford unicompartmental knee arthroplasty for medial compartment osteoarthropathy:a single center's experience for 10 years].

作者信息

Wang H Y, Wang Y, Yang R X, Wang Y H, Hu C, Li L G, Liu Y S, Tian S S, Sun Kang

机构信息

Department of Orthopedics,the Affiliated Hospital of Qingdao University,Qingdao 266000,China.

Department of Gynecology,Qingdao Women's and Children's Hospital,Qingdao 266000,China.

出版信息

Zhonghua Wai Ke Za Zhi. 2022 Jul 1;60(7):703-708. doi: 10.3760/cma.j.cn112139-20220127-00039.

Abstract

To investigate the long-term outcomes of minimally invasive Oxford phase Ⅲ unicompartmental knee arthroplasty (UKA) for patients with medial compartment osteoarthropathy. The clinical data of 594 patients (701 knees) who underwent minimally invasive UKA with Oxford phase Ⅲ unicompartmental prosthesis at Department of Orthopedics,the Affiliated Hospital of Qingdao University from January 2007 to January 2016 were retrospectively analyzed.There were 155 males and 439 females,aged (62.6±10.9) years (range: 44 to 81 years),with a body mass index of (26.9±3.8) kg/m (range: 21.1 to 36.2 kg/m).There were 359 left knees and 342 right knees,676 knees with osteoarthritis and 25 knees with idiopathic osteonecrosis of the medial femoral condyle.There were 487 cases underwent UKA (66 cases underwent UKA on one side and total knee arthroplasty on the other) and 107 cases underwent bilateral UKA.Patients' prosthetic survival,complications,range of motion(ROM) of the knee,visual analogue score (VAS),Western Ontario and McMaster University (WOMAC) osteoarthritis index,and American knee society score (KSS) were collected to assess clinical outcomes.Paired sample test was used to compare the data before and after operation. All patients completed the surgery successfully.There was no intraoperative fractures,postoperative infections or symptomatic vascular embolic disease occurred.The postoperative complications,including mobile bearing dislocation,prosthesis loosening,tibial plateau collapse,the lateral compartment degeneration and postoperative pain were occurred in 18 cases (3.0%,18/594).Thirteen patients suffered complications were transferred to total knee arthroplasty,4 underwent partial revision,if this was used as the endpoint of the study,the surgical success rate was 97.1% (577/594) and the prosthetic revision rate was 2.9%.The ROM was improved from(105.9±11.8)°preoperatively to (114.0±13.3)° at the last follow-up (=10.796,<0.01);the KSS clinical score was increased from 54.3±3.6 to 90.1±6.0 (<0.01) and the functional score was increased from 55.9±3.9 to 87.5±5.7(=124.325,<0.01;=110.985,<0.01).The WOMAC osteoarthritis index was decreased from 54.8±6.7 to 9.2±3.1 at the last follow-up(=150.860,<0.01) and the VAS was decreased from 6.1±1.1 to 1.5±1.0 at the last follow-up(=74.941,<0.01). Minimally invasive Oxford phase Ⅲ UKA for medial compartment knee osteoarthritis has a favorable prosthesis survival rate,low revision rate,and few complications at long-term follow-up.Patients have significant improvement in knee function with satisfactory clinical outcomes.

摘要

探讨微创牛津Ⅲ期单髁膝关节置换术(UKA)治疗内侧间室骨关节炎患者的长期疗效。回顾性分析2007年1月至2016年1月在青岛大学附属医院骨科接受微创牛津Ⅲ期单髁假体UKA治疗的594例患者(701膝)的临床资料。其中男性155例,女性439例,年龄(62.6±10.9)岁(范围:44至81岁),体重指数为(26.9±3.8)kg/m²(范围:21.1至36.2 kg/m²)。左膝359例,右膝342例,骨关节炎676膝,内侧股骨髁特发性骨坏死25膝。487例接受UKA(66例一侧行UKA,另一侧行全膝关节置换术),107例接受双侧UKA。收集患者的假体生存率、并发症、膝关节活动范围(ROM)、视觉模拟评分(VAS)、西安大略和麦克马斯特大学(WOMAC)骨关节炎指数及美国膝关节协会评分(KSS)以评估临床疗效。采用配对样本检验比较手术前后数据。所有患者均成功完成手术。术中无骨折、术后无感染或有症状的血管栓塞性疾病发生。术后并发症包括活动平台脱位、假体松动、胫骨平台塌陷、外侧间室退变及术后疼痛,共18例(3.0%,18/594)。13例出现并发症的患者转为全膝关节置换术,4例行部分翻修,若以此作为研究终点,手术成功率为97.1%(577/594),假体翻修率为2.9%。ROM从术前的(105.9±11.8)°提高到末次随访时的(114.0±13.3)°(t = 10.796,P < 0.01);KSS临床评分从54.3±3.6提高到90.1±6.0(P < 0.01),功能评分从55.9±3.9提高到87.5±5.7(t = 124.325,P < 0.01;t = 110.985,P < 0.01)。末次随访时WOMAC骨关节炎指数从54.8±6.7降至9.2±3.1(t = 150.860,P < 0.01),VAS从6.1±1.1降至1.5±1.0(t = 74.941,P < 0.01)。微创牛津Ⅲ期UKA治疗内侧间室膝关节骨关节炎长期随访时假体生存率良好,翻修率低,并发症少。患者膝关节功能有显著改善,临床疗效满意。

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