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术前髌股关节退变对Oxford膝关节内侧单髁置换术疗效的影响

Influence of patellofemoral joint degeneration on outcome of medial unicompartmental knee arthroplasty

摘要:

目的 探讨术前膝关节疼痛部位及髌股关节退变对Oxford内侧单髁置换术(UKA)疗效的影响.方法 回顾性分析2013年3月至2014年7月新疆医科大学第一附属医院骨科采用单侧Oxford内侧UKA治疗的58例(58膝)膝关节内侧间室骨关节炎患者的资料,男性24例,女性34例,年龄43~87岁,平均68.5岁.体重指数19.7~31.5 kg/m2,平均25.2 kg/m2.根据术前膝关节疼痛位置分为前内侧疼痛组(35例)、膝前疼痛组(17例)、全膝关节疼痛组(6例);根据术前髌股关节退变情况按照Ahlback分级分为髌股关节退变组(16例)和无髌股关节退变组(42例);按照Altman评分分为内侧髌股关节退变组(20例)、外侧髌股关节退变组(12例)、无髌股关节退变组(26例);术中以Outerbridge分级分为髌股关节退变组(21例)和无髌股关节退变组(37例).采用牛津膝关节评分(OKS)、美国西安大略和麦克马斯特大学(WOMAC)骨关节炎指数、Lonner髌股关节评分系统对手术前后膝关节疼痛和功能进行评估.组间两两比较采用t检验,三组之间比较采用方差分析.结果所有患者均获得随访,随访时间26~42个月,平均33个月,未发生感染、脂肪栓塞、下肢深静脉血栓及假体松动等并发症.与术前相比,末次随访时前内侧疼痛组、膝前疼痛组和全膝关节疼痛组患者OKS降低(18.9±3.5比38.9±4.7、19.3±4.2比39.6±4.6、18.1±3.2比38.1±3.7)(t=5.64~7.08,P值均<0.01)、WOMAC骨关节炎指数降低(10.9±2.3比53.2±4.5、10.4±2.1比54.6±3.4、11.7±1.8比52.8±3.7)(t=14.50~19.16,P值均<0.01)、Lonner髌股关节评分升高(88.9±3.4比38.6±2.8、87.5±4.1比38.2±2.3、88.2±3.2比37.6±3.5)(t=-19.78~-18.16,P值均<0.01).以Ahlback标准分级,与术前相比,末次随访时无髌股关节退变组和髌股关节退变组患者OKS降低(18.3±2.4比38.7±4.4和19.6±1.8比38.4±3.1)(t=7.05、9.08,P值均<0.01)、WOMAC骨关节炎指数降低(10.6±2.6比53.2±4.5和12.1±1.4比52.4±3.3)(t=14.21、19.52,P值均<0.01),Lonner髌股关节评分升高(88.1±3.1比38.3±3.3和86.9±2.6比39.1±2.4)(t=-18.90、-23.40,P值均<0.01);以Altman及Outerbridge分级进行比较研究结果一致.根据Ahlback分级,末次随访时无髌股关节退变组和髌股关节退变组间各项评分间差异无统计学意义;根据Altman分级,与无髌股关节退变组相比,外侧髌股关节退变组OKS、WOMAC骨关节炎指数升高(20.2±1.4比18.2±2.7、12.5±1.7比10.5±2.5)(t=-4.30,P=0.03;t=-4.80,P=0.02)、Lonner髌股关节评分降低(84.3±2.8比87.4±3.2)(t=-6.20,P=0.01);根据Outerbridge分级,与无髌股关节退变组相比,末次随访时髌股关节退变组的各项评分差异均无统计学意义(P>0.05).结论 术前膝关节疼痛位置及伴有轻至中度髌股关节退变并不影响Oxford内侧单髁置换术短期疗效,影像学及术中证实的髌股关节退变不应作为UKA的绝对禁忌证,但对外侧髌股关节退变患者,不推荐将UKA作为首选治疗方式.

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abstracts:

Objective To evaluate the influence of patellofemoral joint degeneration and pre-operative pain location on the outcome of medial Oxford unicompartmental knee arthroplasty (UKA). Methods A total of 58 patients (58 knees) with medial Oxford UKA had been performed for medial osteoarthritis from March 2013 to July 2014 in Department of Orthopaedic Surgery at First Teaching Hospital of Xinjiang Medical University were retrospective reviewed. There were 24 males and 34 females, the age from 43 to 87 years with the mean age was 68.5 years. The mean body mass index was 25.2 kg/m2 ranging from 19.7 to 31.5 kg/m2. Patients were divided into anterior-medial pain group (35 knees), anterior knee pain group (17 knees) and general knee pain group (6 knees) according to pre-operative pain location. Pre-operative radiological statuses of the patellefemoral joint were defined by Ahlback system and divided into patellofemoral joint degeneration group (16 knees) and normal group (42 knees). Patients were also divided into medial patellofemoral degeneration group (20 knees), lateral patellofemoral degeneration group (12 knees) and normal group (26 knees) according to Altman scoring system. Outerbridge system was used intraoperatively and the patients were divided into patellofemoral joint degeneration group (21 knees) and normal group (37 knees). Pre-and post-operative outcomes were evaluated with Oxford Knee Score (OKS), Western Ontario and MacMaster (WOMAC) and patellofemoral score system of Lonner. T test and ANOVA were used to analyze the data. Results The average duration of follow-up was 33 months (from 26 to 42 months). There were no patients had complications of infection, deep vein thrombosis, dislocation or loosing at the last follow-up. Compared to pre-operation, OKS (18.9±3.5 vs.38.9±4.7, 19.3±4.2 vs. 39.6±4.6, 18.1±3.2 vs. 38.1±3.7)(t=5.64 to 7.08, all P<0.01) and WOMAC (10.9±2.3 vs.53.2±4.5, 10.4±2.1 vs.54.6±3.4, 11.7±1.8 vs.52.8±3.7)(t=14.50 to 19.16, all P<0.01) decreased, and the Lonner score (88.9±3.4 vs.38.6±2.8, 87.5±4.1 vs.38.2±2.3, 88.2±3.2 vs. 37.6±3.5)(t=-19.78 to -18.16, all P<0.01) increased significantly in anterior-medial pain group, anterior knee pain group and general knee pain group. According to Ahlback scoring system, compared to pre-operation, OKS (18.3±2.4 vs. 38.7±4.4,19.6±1.8 vs. 38.4±3.1)(t=7.05,9.08,both P<0.01) and WOMAC (10.6 ±2.6 vs.53.2±4.5,12.1±1.4 vs.52.4±3.3)(t=14.21,19.52,both P<0.01) decreased, the Lonner score (88.1±3.1 vs.38.3±3.3,86.9±2.6 vs.39.1±2.4)(t=-18.90,-23.40,both P<0.01) increased significantly in patellofemoral joint degeneration group and normal group, the outcomes were the same according to Altman and Outerbridge scoring system. There was no significant difference between patellofemoral joint degeneration group and normal group based on Ahlback grading system.According to Altman classification, compared to normal group, there was no statistically differences in OKS, WOMAC and Lonner scoring system between patients with degeneration in the medial patellofemoral joint group, OKS and WOMAC increased (20.2±1.4 vs.18.2±2.7,12.5±1.7 vs.10.5±2.5) (t=-4.30,P=0.03;t=-4.80,P=0.02), the Lonner score decreased (84.3±2.8 vs.87.4±3.2) (t=-6.20,P=0.01) in lateral patellofemoral degeneration group. According to Outerbridge scoring system, there were no statistically differences in patients in patellofemoral joint degeneration group and normal group.Conclusions There is a good evidence that neither mild to moderate degree of patellofemoral joint degeneration nor pre-operative pain location will compromise the short-term outcome of medial Oxford UKA, and should not be considered as contraindications. The situation is less clear for lateral patellofemoral degeneration, and more cautious option is advised.

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作者: 胥伯勇 [1] 纪保超 [1] 郭文涛 [1] 穆文博 [1] 曹力 [1]
第一作者: 胥伯勇
期刊: 《中华外科杂志》2017年55卷6期 416-422页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2017.06.004
发布时间: 2017-06-30
基金项目:
新疆维吾尔自治区重大科技专项项目 乌鲁木齐市科学技术计划项目(Y151310024)Major Science and Technology Project of Xinjiang Uygur Autonomous Region Science and Technology Projects in Xinjiang Urumqi
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