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胫骨假体后倾对Oxford单髁关节置换术后短期临床结果的影响

Influence of tibial component slope on short-term clinical outcome for Oxford unicompartmental knee arthroplasty

摘要:

目的 探讨采用微创器械(MP)行Oxford单髁关节置换术(UKA)后不同胫骨假体后倾角度( PTS)对短期临床结果的影响. 方法 回顾性分析2014年1月至2015年12月于中日友好医院骨关节外科行内侧Oxford UKA的116例( 128膝)患者资料,共100例( 108膝)患者符合纳入排除标准,男性31例,女性69例,年龄47~90岁,平均672岁,平均身高(1619±84)cm,体重指数(262± 33 ) kg/m2. 在膝关节侧位X线片上分别测量手术前后的PTS,根据术后PTS的角度将患者分为<3°组、3°~5°组、5°~7°组、7°~9°组和>9°组,记录牛津膝关节评分( OKS). 采用独立样本t检验、方差分析和Pearson相关性分析进行统计学分析. 结果 所有患者均顺利完成手术,无输血、感染、血栓等并发症发生. 1例患者术后1周出现聚乙烯垫片脱位行翻修手术,术后恢复良好. 术前PTS为96°±34°,术后PTS为65°±22°,差异有统计学意义(t=9053,P<001),仅3例超出推荐误差( 2°~12° ). 82例( 86膝)患者获得随访,随访时间 1~29 年,平均 2 年;OKS 为 31~48 分,平均(430±41)分. 术后12例(12膝)患者PTS增大,OKS为(405±52)分;70例(74膝)患者PTS减小,OKS为(434±38)分. PTS 增大和 PTS 减小患者的 OKS 差异有统计学意义(t=2347,P=0021). 术后PTS角度<3°组、3°~5°组、5°~7°组、7°~9°组和>9°组之间的OKS差异无统计学意义.术后PTS与术前PTS呈正相关(r=0201,95%CI:0001~0396,P=0037);与身高和体重指数无相关性( P>005). OKS与术后PTS和手术前后PTS的变化呈负相关( r=-0255,95%CI:-0063~-0427,P=0018;r=-0292,95%CI: -008~-0475,P<001). 结论 采用MP技术行Oxford UKA可获得满意的术后PTS. 术后PTS减小时临床结果更佳,建议避免术后PTS过大.

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abstracts:

Objective To investigate the effects of tibial component slope change after microplasty ( MP ) Oxford unicompartmental knee arthroplasty ( UKA ) on short-term clinical outcome Methods A total of 116 patients ( 128 UKAs ) underwent UKA in Department of Orthopaedic Surgery of China-Japan Friendship Hospital between January 2014 and December 2015 were retrospectively reviewed Totally 100 patients ( 108 UKAs) were finally included in the study There were 31 males and 69 females, aging from 47 to 90 years (mean 672 years) The mean height was (1619±84) cm and the mean body mass index (BMI) was (262±33) kg/m2 The posterior tibial slope (PTS) at preoperative and postoperative were measured on the lateral radiograph The postoperative PTS were divided into five groups (<3°,3° to 5°,5° to 7°,7° to 9° and>9°). The Oxford Knee Score (OKS) was recorded Pearson correlation analysis, ANOVA and t test were used to analyze data Results All operations were successfully accomplished and there were no transfusion, infection, thrombus and other complications There was 1 patient accepted revision because of bearing dislocation Compared to preoperative, the PTS decreased ( 65° ± 22° vs96°±34°) postoperative, there was statistical difference (t=9053,P<001) Only 3 patients were beyond the recommended range (2° to 12°) A total of 82 patients (86 UKAs) were followed up The follow-up time was 1 to 29 years (mean 2 years) The OKS was 430±41 (mean 31 to 48)The PTS increased in 12 patients (12 UKAs) postoperative, the mean OKS was 405±52 The PTS decreased in 70 patients ( 74 UKAs ) , the mean OKS was 434 ± 38 There were significant difference in OKS ( t=2347, P=0021 ) There were no significant difference in OKS between the five groups. There were positive correlation between postoperative PTS and preoperative PTS ( r=0201,95%CI:0001 to 0396,P=0037) , there were no correlations between postoperative PTS and hight and BMI. There were negative correlations between OKS and postoperative PTS ( r=-0255,95%CI: -0063 to -0427,P=0018) and PTS change (r=-0292,95%CI: -008 to -0475,P<001) Conclusions Satisfying PTS can be obtained by use of Oxford MP instrumentation The clinical outcome of the postoperative PTS decreased was relatively better Too large posterior slope of the tibial implant should be avoided.

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