摘要
目的评估胫骨平台后倾0°截骨在前交叉韧带功能缺陷固定平台单髁置换术中应用效果。方法纳入自2019-01—2019-12行单髁置换术治疗的98例膝关节前内侧骨性关节炎,术前进行膝关节X线片与MRI检查,术中直视下再次确认前交叉韧带功能是否正常,前交叉韧带功能缺陷者进行胫骨平台后倾0°截骨(A组),前交叉韧带功能正常者进行胫骨平台后倾7°截骨(B组)。比较A组与B组膝关节活动度、膝关节WOMAC评分、膝关节AKS评分、膝关节疼痛VAS评分、膝关节遗忘评分、股骨外髁后滚距离。结果98例手术顺利完成,无神经损伤、心脑血管意外事件发生。所有患者术后均获得至少2年随访,末次随访时膝关节正侧位X线片显示假体位置良好,屈伸间隙平衡,未出现假体松动;患者膝关节疼痛消失,膝关节活动度恢复良好,无膝前疼痛发生,由坐到起的过程中无膝关节发软、不稳情况发生。末次随访时A组与B组膝关节活动度、膝关节WOMAC评分、膝关节AKS评分、膝关节疼痛VAS评分、膝关节遗忘评分、股骨外髁后滚距离比较差异无统计学意义(P>0.05)。结论前交叉韧带功能缺陷患者固定平台单髁置换术中通过将胫骨平台后倾角调为0°(避免前倾)可替代前交叉韧带功能,减少膝关节屈曲过程中胫骨前移距离,同时减少股骨髁相对胫骨平台的滑动及后滚,提高膝关节稳定性。
Objective To evaluate the effect of 0°posterior tibial slope osteotomy in unicompartmental knee arthroplasty of fixed platform with anterior cruciate ligament dysfunction.Methods Ninety-eight patients with anterior medial knee osteoarthritis who underwent unicompartmental knee arthroplasty from January 2019 to December 2019 were included in this study.The knee X-ray and MRI were performed before operation.The function of ACL was checked again if it was normal under direct vision during operation.Patients with ACL dysfunction underwent 0°posterior tibial plateau osteotomy(group A)while patients with normal ACL function underwent 7°posterior tibial plateau osteotomy(group B).The range of motion,WO MAC score,AKS score,VAS score,forgetting joint score and posterior roll distance of lateral femoral condyle were compared between group A and group B.Results The operation was successfully completed in 98 cases without nerve injury or cardiovascular and cerebrovascular accidents.All patients were followed up for at least 2 years.At the last follow-up,the anteroposterior and lateral knee X-ray films showed that the prosthesis was in good position,the flexion and extension gap was balanced,and there was no prosthesis loosening.The knee pain disappeared,and the range of motion of the knee recovered well.No anterior knee pain occurred,and no knee weakness or instability occurred in the process of sitting up.At last follow-up,there were no significant differences in knee range of motion,WO MAC score,AKS score,VAS score,forgetting joint score,and posterior roll distance of femoral lateral condyle between group A and group B(P>0.05).Conclusion The function of the anterior cruciate ligament can be replaced by adjusting the posterior tilt angle of the tibial plateau to 0°(avoiding anteversion),which can reduce the forward tibial distance during flexion,also reduce the sliding and backward roll of the femoral condyle relative to the tibial plateau,and improve the stability of the knee joint.
作者
李锋侦
司文腾
邹士平
陈成亮
王跃辉
LI feng-zhen;SI Wen-teng;ZOU Shi-ping;CHEN Cheng-liang;WANG Yue-hui(Department of Joint Surgery,Zhengzhou City Orthopedics Hospital,Zhengzhou,Henan 450052,China)
出处
《中国骨与关节损伤杂志》
2022年第12期1248-1252,共5页
Chinese Journal of Bone and Joint Injury
关键词
膝关节前内侧骨性关节炎
单髁置换术
固定平台假体
胫骨平台后倾0°截骨
Anteromedial osteoarthritis of the knee
Unicompartmental knee arthroplasty
Fixed platform prosthesis
0°posterior tibial plateau osteotomy
