摘要
背景:膝关节自发性骨坏死主要影响股骨内侧髁,是膝关节单髁置换的良好适应证,但对于单髁置换后的治疗效果仍有争议。目的:探讨活动平台单髁置换治疗膝关节自发性骨坏死随访5年的临床效果。方法:回顾性分析2014年1月至2015年1月在佛山市中医院骨关节科诊断为膝关节内侧间室自发性骨坏死并行活动平台单髁置换治疗的患者资料,按照纳入与排除标准,纳入64例患者。收集患者年龄、性别、体质量、骨坏死部位、Koshino分期和坏死体积等资料进行分析,采用膝关节最大活动度、美国特种外科医院评分、牛津膝关节评分、疼痛目测类比评分评估术前和随访时膝关节功能,术前和随访时均通过双下肢全长X射线片评估下肢力线情况,同时观察有无并发症发生。结果与结论:①62例患者为股骨内髁骨坏死,2例患者胫骨内侧平台骨坏死;Koshino分期Ⅲ期40例,Ⅳ期24例;病变体积5.62-32.52cm^3,小体积坏死45例,中体积坏死14例,大体积坏死5例;②所有患者手术切口均Ⅰ期愈合,随访60-72个月;其中1例患者术后3个月出现聚乙烯衬垫脱位,再次手术使用加厚垫片后功能良好;2例患者术后4年出现假体松动,翻修成全膝关节置换;其余患者随访期间均无感染、假体脱位、假体松动、下肢静脉血栓形成、肺栓塞、心脑血管意外、创伤后精神障碍等并发症发生;③末次随访时,所有患者美国特种外科医院评分、牛津膝关节评分、膝关节活动度、目测类比评分均较术前明显改善,差异有显著性意义(P<0.05);④末次随访时,所有患者髋膝踝角、胫股角均较术前明显改善(P<0.05),患者下肢力线得到纠正;⑤提示采用活动平台单髁置换治疗膝关节自发性骨坏死具有创伤小、骨量保留多、术后恢复快、下肢力线改善明显、术后关节功能良好的优点,中期疗效满意。
BACKGROUND: Spontaneous osteonecrosis of knee joint mainly affects the medial condyle of femur and is a good indication for unicompartmental knee arthpoplasty. However, the therapeutic effect after unicompartmental knee arthpoplasty is still controversial. OBJECTIVE: To explore the clinical effect of movable platform unicompartmental knee arthpoplasty for knee spontaneous osteonecrosis in 5-year follow-up. METHODS: From January 2014 to January 2015, the data of patients diagnosed as spontaneous osteonecrosis of medial compartment of knee joint and treated with unicompartmental knee arthpoplasty of mobile platform in the Department of Arthrology of Foshan Hospital of Traditional Chinese Medicine were analyzed retrospectively. Totally 64 patients were included according to the inclusion and exclusion criteria. The data of age, sex, body weight, necrotic site, Koshino stage and necrotic volume were collected and analyzed. Knee maximum range of motion, American Special surgery Hospital score, Oxford knee joint score and visual analogue scale pain score were used to evaluate knee function before and during follow-up. Preoperative and follow-up evaluations of the lower extremity line of force were performed through full-length X-ray films of both lower extremities, and the presence of complications was observed. RESULTS AND CONCLUSION:(1) Sixty-two patients affected femoral metatarsal necrosis;two patients had medial tibial plateau necrosis;40 patients had Koshino stage III;24 cases had stage IV;lesion volume was 5.62 to 32.52 cm^3;45 cases had small-area necrosis;and 14 cases had middle area necrosis. There were five cases of large-area necrosis.(2) All the patients were healed by stage I. The follow-up period was 60-72 months. One patient had dislocation of the polyethylene liner 3 months after surgery and was used again for surgery. The function was good after thickening the pads. Two patients showed loosening of the prosthesis 4 years after the operation, and were revised to total knee replacement. The remaining pa
作者
牛国庆
彭智浩
温建强
潘耀成
卢国良
Niu Guoqing;Peng Zhihao;Wen Jianqiang;Pan Yaocheng;Lu Guoliang(Sixth Department of Orthopedics,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,Guangdong Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2020年第33期5283-5288,共6页
Chinese Journal of Tissue Engineering Research
基金
广东省医学科学技术研究基金项目(20161181228306),项目参与人:牛国庆
关键词
骨
膝
骨坏死
关节
单髁置换
活动平台
假体
随访
bone
knee
osteonecrosis
joint
unicompartmental knee arthpoplasty
mobile platform
prosthesis
follow up
