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牛津单髁置换术应用于单间室部分软骨损伤的疗效研究
Effect of Oxford unicompartmental knee arthroplasty on unicompartmental partial thickness cartilage loss
投稿时间:2022-05-24  
DOI:10.3969/j.issn.1672-5972.2023.01.005
中文关键词:  单髁置换术  骨性关节炎  软骨
英文关键词:Unicompartmental knee arthroplasty  Osteoarthritis  Cartilage
基金项目:上海市卫健委面上科研项目(201940249)
作者单位邮编
涂意辉* 同济大学附属杨浦医院骨关节外科上海200090 200090
马童 同济大学附属杨浦医院骨关节外科上海200090 200090
薛华明 同济大学附属杨浦医院骨关节外科上海200090 200090
文涛 同济大学附属杨浦医院骨关节外科上海200090 200090
薛龙 同济大学附属杨浦医院骨关节外科上海200090 200090
杨涛 同济大学附属杨浦医院骨关节外科上海200090 200090
冀家中 同济大学附属杨浦医院骨关节外科上海200090 200090
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中文摘要:
      目的 评估膝关节单髁置换术治疗部分软骨磨损单间室骨性关节炎的疗效。方法 回顾性分析2008年4月至2019年4月在同济大学附属杨浦医院采用膝关节单髁置换术治疗的102例(115膝)内侧间室软骨部分磨损(PTCL)膝骨性关节炎的患者资料,经匹配年龄、性别、体重指数和随访时间的102例(115膝)软骨全层磨损(FTCL)的患者为对照组。采用OKS评分、AKS评分和疼痛视觉模拟评分(VAS评分)对术前、术后膝关节功能进行评估,X线进行影像学评估。结果 所有患者均获得了完整的随访,术后平均随访(60.0±19.6)个月(24 ~ 152个月)。FTCL组和PTCL组患者术后末次随访OKS评分、AKS-Knee评分、AKS-Function评分、VAS评分均较术前明显改善(P<0.05)。术后1年、2年和末次随访,PTCL与FTCL组间OKS评分、AKS-Knee评分、AKS-Function评分、VAS评分比较,差异无统计学意义(P>0.05)。共有6膝翻修,FTCL组3膝(2.6%),PTCL组3膝(2.6%)。结论 不能简单地将PTCL视为膝关节单髁手术禁忌证,应该根据软骨损伤的程度和范围进一步细分以选择治疗方案。Ⅲ型和Ⅳ型软骨损伤有着与FTCL相同的临床疗效,负重位X线对软骨损伤有很好的提示作用,当比值内外侧间室高度比值≤30%,UKA多可取得良好的手术效果。
英文摘要:
      Objective To evaluate the effect of unicompartmental knee arthroplasty (UKA) on unicompartmental osteoarthritis with partial thickness cartilage loss (PTCL).Methods From April 2008 to April 2019, 102 patients (115 knees) with medial compartment PTCL undergoing UKA for anteromedial osteoarthritis (AMOA) in Yangpu Hospital, School of Medicine, Tongji Uniersity, and 102 patients (115 knees) with full thickness cartilage loss (FTCL) with matched age, gender, body mass index (BMI), and follow-up time were used as the control group. Preoperative and postoperative knee functions were assessed using the OKS score, AKS score, and visual analogue scale (VAS), and X-ray imaging assessment was performed.Results All patients had complete follow-up data with an average postoperative follow-up time of (60.0±19.6) months (24-152 months). At the last postoperative follow-up, the two groups of OKS score, AKS-Knee score, AKS-Function score and VAS were significantly higher than those preoperatively (P<0.05). The scores at the follow-up between the PTCL group and FTCL group were similar, with OKS score, AKS-Knee score, AKS-Function score, and VAS, and the differences had no statistical significance (P>0.05). There were 6 knees receiving revision, including 3 knees (2.6%) in the FTCL group and 3 knees (2.6%) in the PTCL group.Conclusion PTCL cannot be simply considered as a UKA contraindication, instead, it should be further subdivided according to the degree and extent of cartilage injury to select a therapeutic regimen. Type Ⅲ and Ⅳ cartilage injuries have the same clinical features as FTCL, and should not be regarded as surgical contraindications. Weight-bearing X-ray had a good suggestive effect on cartilage injury, and when the joint space ratio of medial to lateral compartments≤30%, UKA could obtain good surgical effect.
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