两种对线方法在活动平台单髁置换术后的近期疗效对比

作者	单位	邮编
刘明强^*	河南省洛阳正骨医院膝关节外科,河南郑州,450000	450000
刘沛^*	河南省洛阳正骨医院膝关节外科,河南郑州,450000	450000
申晟	河南省洛阳正骨医院膝关节外科,河南郑州,450000	450000
李建垒	河南省洛阳正骨医院膝关节外科,河南郑州,450000	450000
陈森	河南省洛阳正骨医院麻醉科,河南郑州,450000	450000

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中文摘要:

目的比较机械对线（mechanical alignment, MA）与运动对线（kinematical alignment, KA）在活动平台单髁置换术（unicompartmental knee arthroplasty, UKA）后近期的临床效果。方法回顾性分析河南省洛阳正骨医院2020年3月至2022年1月收治的94例活动平台UKA患者资料，其中MA组53例，KA组41例。临床疗效方面，记录两组患者的切口长度、手术时间和术中失血量，同时记录术前，术后3个月、6个月、1年及2年的关节活动度（ROM）、遗忘关节评分（forgotten joint score, FJS）和牛津膝关节评分（oxford knee score, OKS）。影像学方面，判断假体是否松动、移位、下沉及垫片脱位，并测量胫骨近端内侧角（medial proximal tibial angle, MPTA）、股骨远端外侧角（lateral distal femoral angle, LDFA）。根据LDFA-MPTA和LDFA+MPTA结果分别计算髋膝踝关节角（hip knee ankle angle, HKA）和关节线倾斜角（joint line obliquity, JLO）。结果 94例患者均获得24 ～ 30个月的随访，平均（26.32±2.64）个月。末次随访时，两组患者假体存活率均为100%。与MA组相比，KA组术中出血更少，手术时间更短，差异均有统计学意义（P＜0.05）。两组患者的ROM均较术前明显改善（P＜0.05），但组间比较，差异无统计学意义（P＞0.05）。术后各时间点的FJS评分比较，差异无统计学意义（P＞0.05）；OKS评分方面，除术后3个月外，KA组在术后6个月、1年及末次随访时均优于MA组（P＜0.05）。影像学方面，两组MPTA角比较，差异无统计学意义（P＞0.05），但KA组的LDFA角较MA组小（P＜0.05）。结论对于活动平台UKA，无论采用KA技术还是MA技术，术后早期均能够获得良好的临床疗效。与MA技术相比，KA技术术中出血少，手术时间更短，术后关节功能评分更高。

英文摘要:

Objective To compare the clinical effects of mechanical alignment (MA) and kinematical alignment (KA) after unicompartmental knee arthroplasty (UKA).Methods A retrospective study at Henan Luoyang Orthopedic Hospital, from March 2020 to January 2022 identified 94 UKA patients (53 cases in MA group and 41 cases in KA group). In terms of clinical efficacy, incision length, operation time and intraoperative blood loss were recorded in the two groups. The knee range of motion (ROM), Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) were recorded pre-operatively, 3 months, 6 months, 1 year and 2 years post-operatively in both groups. Radiographs were taken to determine if the prosthesis was loose, dislocated, depressed, or if the seal was dislocated. Meanwhile, the medial proximal tibial angle (MPTA) and the lateral distal femoral angle (LDFA) were measured. The arithmetic hip-knee-ankle angle (HKA) and joint line obliquity (JLO) were calculated from the LDFA - MPTA and LDFA+MPTA results, respectively.Results At the last follow-up, the prosthesis survival rate was 100% in both groups. Compared with the MA group, the KA group had less intraoperative bleeding and shorter operation time, and the differences were statistically significant (P<0.05). ROM was significantly improved in both groups compared with preoperative values (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in FJS at any time after surgery. In terms of OKS, the KA group was better than the MA group at 6 months, 1 year and the last follow-up except at 3 months post-operatively. There was no significant difference in MPTA between the two groups (P>0.05), but there was a significant difference in LDFA between the two groups (P<0.05).Conclusion For mobile platform UKA, both KA group and MA group can achieve good clinical effect in the early post-operative period. Compared with MA group, KA group has less intraoperative bleeding, shorter operative time and higher postoperative joint function score.

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