摘要
目的探讨使用牛津第三代单髁系统治疗膝关节自发性骨坏死的患者术后临床近期疗效。方法回顾性分析从2014年1月至2016年1月在广东省中医院关节科行牛津单髁置换术治疗的30例(30膝)明确诊断为膝关节内侧髁自发性坏死的患者,其中男性10例10膝,女性20例20膝;术后随访。收集统计患者年龄、性别、体重、坏死部位、大小、Koshino分期和坏死部位/髁比例、坏死面积等资料进行分析;观察有无单髁置换术(UKA)术后并发症出现;同时分别采用美国特种外科医院膝关节评分(HSS)、美国膝关节协会评分(KSS)、膝关节最大活动度(ROM)对术前及末次随访时膝关节功能进行评估。再者手术前后均行患侧膝关节正侧位X线片及双下肢全长负重位X线片评估下肢力线。采集资料建立数据库、将数据导入SPSS 18.0统计软件进行数据分析,术前术后的数据均值比较均采用配对样本t检验。结果所有患者均为股骨内髁骨坏死,Koshino分期Ⅲ期20例,Ⅳ期10例。平均年龄(65.7±3.2)岁;平均体重(64.9±1.3)kg;坏死部位宽度和髁的比例20%~60%,其中24例<50%,6例>50%;病变体积4.3~31.3 cm3,小面积坏死22例,中面积坏死6例、大面积坏死2例;所有患者手术切口均为甲级愈合。所有患者均无输血、感染、肺栓塞、深静脉血栓、假体周围骨折等围手术期并发症出现;平均随访(14.8±2.4)个月(3~36个月);所有患者术后疼痛减轻,与术前比较,KSS临床和功能评分(临床t=14.09,功能t=12.62)、HSS评分(t=13.05)、膝关节活动度(t=5.77)、股胫角(t=3.49)等均有明显改善(均为P<0.01)。结论对于膝关节自发性骨坏死的患者,利用第三代牛津单髁系统,采用微创单髁技术行手术治疗,术后疗效满意,其远期效果有待进一步的观察。
Objective To investigate the clinical effect of Oxford third generation of single condyle system in the treatment of spontaneous bone necrosis of knee joint. Methods A respective analysis was carried out. From January 2014 to January 2016,30 cases（ 30 knees） were diagnosed as the spontaneous necrosis of medial condyle of knee in the joint department of the Guangdong Provincial Hospital. Among them,10 males were 10 knee,20 femals were 20 knees; the postoperative follow-up was carried out. The data of age,sex,body weight,necrotic site,size,Koshino staging,necrosis site/condylar ratio and necrosis area were collected and analyzed. The occurrence of postoperative complications after unicompartmental knee arthroplasty（ UKA） was observed,and the functions of knee joint before and after the operation were evaluated with the knee joint score of hospital for special surgery（ HSS）,the American Knee Society score（ KSS） and the maximal range of motion（ ROM）. After the operation,the lateral knee joint and the full length weight-bearing X-ray films of the lower limbs were evaluated to evaluate the force line. SPSS 18. 0 statistic software was used to analyze the data, comparing the preoperative and postoperative data by paired t test. Results All the patients were femoral condyle bone necrosis： 20 cases of Koshino stage Ⅲ,10 cases of stage Ⅳ. The mean age was（ 65. 7 ± 3. 2） years,and the mean weight was（ 64. 9 ± 1. 3） kg; The ratio of the necrotic site and condyle was 20% to 60%,of which 24 cases were less than 50%,six cases were larger than 50%; the lesion volume was 4. 3 ~ 31. 3 cm3. There was small area necrosis in 22 cases,medium area necrosis in six cases. All the patients with surgical incision were primary healing. None of the patients had perioperative complications such as blood transfusion,infection,pulmonary embolism,deep vein thrombosis,or perioperative fractures. The mean follow-up duration was（ 14. 8 ± 2. 4） months（ 3-36 months）. Comparing with the preoperative data,KS
出处
《中华关节外科杂志（电子版）》
CAS
2017年第5期28-34,共7页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
国家自然科学基金(81473700)
广东省科技厅(2014KT1508)
广东省朝阳人才(2014KT1479)
关键词
关节成形术
置换
膝
骨坏死
Arthroplasty, replacement, knee
Osteonecrosis
