单髁置换治疗中青年患者膝内侧间室骨关节炎的近期随访
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摘要
背景:随着手术器械和技术的进步,单髁膝关节置换的临床疗效被越来越多的人肯定,但在国内目前仍缺乏单髁置换治疗相对年轻患者膝内侧间室骨关节炎的相关报道。目的:探讨单髁置换治疗年轻患者膝内侧骨关节炎的临床疗效。)方法:自2013年6月至2017年6月甘肃省人民医院骨三科采用单髁置换治疗相对年轻患者(年龄<55岁膝内侧骨关节炎患者16例,参照术前、术后疼痛目测类比评分、美国特种外科医院评分、膝关节活动度及下肢影像学胫股角、髋膝踝角评价单髁膝关节置换疗效。结果与结论:(1)术后切口均Ⅰ期愈合,无感染、脂肪栓塞及假体周围骨折等早期并发症发生,下肢深静脉血栓形成1例;(2)16例均获随访,随访时间6-36个月;(3)术后末次随访膝关节疼痛目测类比评分、美国特种外科医院评分及膝关节活动度与术前比较均显著改善(P <0.05);(4)术后胫股角、髋膝踝角与术前比较亦显著改善(P <0.05);(5)结果表明,单髁置换治疗相对年轻的膝关节内侧间室骨关节炎患者具有较好的近期疗效,中远期疗效还需更长时间的随访观察。
BACKGROUND: With the development of surgical instruments and techniques, the unicompartmental knee arthroplasty has been accepted. However, there is still a lack of report on unicompartmental knee arthroplasty for treating medial compartmental knee osteoarthritis in young patients in China. OBJECTIVE: To evaluate the clinical curative effect of unicompartmental knee arthroplasty for medial compartmental knee osteoarthritis in young patients. METHODS: Sixteen patients less than 55 years of age with medial compartmental knee osteoarthritis were treated by unicompartmental knee arthroplasty with Oxford Ⅲ system from June 2013 to June 2017 at Third Department of Orthopedics,Gansu Provincial Hospital. Curative effects were evaluated by Visual Analogue Scale, Hospital for Special Surgery score, range of motion and angle of femorotibial angle and hip-knee-ankle angle before and after surgery. RESULTS AND CONCLUSION:(1) Primary healing of incision was obtained in all patients, and no infection, fat embolism or fracture around the prosthesis occurred except one case of lower limb deep venous thrombosis.(2) All the patients were followed up for 6-36 months.(3) At the postoperative last follow-up, Visual Analogue Scale, Hospital for Special Surgery score, and range of motion of the knee joint were significantly improved compared with the baseline(P < 0.05).(4) The postoperative femorotibial angle and hip-knee-ankle angle were significantly improved compared with the baseline(P < 0.05).(5) These findings suggest that the unicompartmental knee arthroplasty for treating medial compartmental knee osteoarthritis in young patients has a good short-term effect. The moderate-and long-term efficacy needs long follow-up.
BACKGROUND: With the development of surgical instruments and techniques, the unicompartmental knee arthroplasty has been accepted. However, there is still a lack of report on unicompartmental knee arthroplasty for treating medial compartmental knee osteoarthritis in young patients in China. OBJECTIVE: To evaluate the clinical curative effect of unicompartmental knee arthroplasty for medial compartmental knee osteoarthritis in young patients. METHODS: Sixteen patients less than 55 years of age with medial compartmental knee osteoarthritis were treated by unicompartmental knee arthroplasty with Oxford Ⅲ system from June 2013 to June 2017 at Third Department of Orthopedics,Gansu Provincial Hospital. Curative effects were evaluated by Visual Analogue Scale, Hospital for Special Surgery score, range of motion and angle of femorotibial angle and hip-knee-ankle angle before and after surgery. RESULTS AND CONCLUSION:(1) Primary healing of incision was obtained in all patients, and no infection, fat embolism or fracture around the prosthesis occurred except one case of lower limb deep venous thrombosis.(2) All the patients were followed up for 6-36 months.(3) At the postoperative last follow-up, Visual Analogue Scale, Hospital for Special Surgery score, and range of motion of the knee joint were significantly improved compared with the baseline(P < 0.05).(4) The postoperative femorotibial angle and hip-knee-ankle angle were significantly improved compared with the baseline(P < 0.05).(5) These findings suggest that the unicompartmental knee arthroplasty for treating medial compartmental knee osteoarthritis in young patients has a good short-term effect. The moderate-and long-term efficacy needs long follow-up.
引文
[1]Pereira D, Ramos E, Branco J. Osteoarthritis. Acta Med Port.2015;28(1):99-106.
[2]Taruc-Uy RL. Diagnosis and treatment of osteoarthritis. Prim Care. 2013;40(4):821-836.
[3]薛浩,刘岩,冉博,等.膝关节骨性关节炎治疗现状[J].医学综述,2018, 24(2):321-325.
[4]Nankaku M, Ito H, Furu M, et al. Preoperative factors related to the ambulatory status at 1 year after total knee arthroplasty.Disabil Rehabil. 2018;40(16):1929-1932.
[5]Ukachukwu V, Duncan R, Belcher J, et al. Clinical significance of medial versus lateral compartment patellofemoral osteoarthritis:cross-sectional analyses in an adult population with knee pain. Arthritis Care Res(Hoboken).2017;69(7):943-951.
[6]徐彬,裴福兴,马俊,等.单髁关节置换术与全膝关节置换术比较治疗单间室骨关节炎疗效的Meta分析[J].中国循证医学杂志,2015,15(6):652-658.
[7]Marmor L. Marmor modular knee in unicompartmental disease:minimum four-year follow-up. J Bone Joint Surg Am.1979;61:347-353.
[8]Goodfellow JW, Kershaw CJ, Benson MK, et al. The Oxford Knee for unicompartmental osteoarthritis:the frst 103 cases.J Bone Joint Surg Br. 1988;70:692-701.
[9]Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am. 1989,71(1):145-150.
[10]白玉明,张海森,刘畅,等.胫骨高位截骨术治疗单纯内侧间室膝骨关节炎术后炎性细胞因子水平变化研究[J].中国修复重建外科杂志,2017,31(4):422-426.
[11]Prodromos CC, Amendola A, Jakob RP, et al. High tibial osteotomy:indications, techniques, and postoperative management. Instr Course Lect. 2015;64:555-565.
[12]Ryu SM, Park JW, Na HD, et al. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis with kissing lesions in relatively young patients.Knee Surg Relat Res. 2018;30(1):17-22.
[13]Yokoyama M, Nakamura Y, Egusa M, et al. Factors related to stress fracture after unicompartmental knee arthroplasty. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2018;1(15):1-5.
[14]Ghomrawi HM, Eggman AA, Pearle AD. Effect of age on cost-effectiveness of unicompartmental knee arthroplasty compared with total knee arthroplasty in the U.S. J Bone Joint Surg Am. 2015; 97(5):396-402.
[15]Ryu SM, Park JW, Na HD, et al. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis with kissing lesions in relatively young patients.Knee Surg Relat Res. 2018;30(1):17-22.
[16]van der List JP, Chawla H, Villa JC, et al. The role of patient characteristics on the choice of unicompartmental versus total knee arthroplasty in patients with medial osteoarthritis. J Arthroplasty. 2016;32(3):761-766.
[17]Kim KT, Lee S, Lee JS, et al. Long-term clinical results of nicompartmental knee arthroplasty in patients younger than60 years of age:minimum 10-year follow-up. Knee Surg Relat Res. 2018;30(1):28-33.
[18]Greco NJ, Lombardi AV Jr, Price AJ, et al. Medial mobile-bearing unicompartmental knee arthroplasty in young patients aged less than or equal to 50 years. J Arthroplasty.2018;33(8):2435-2439.
[19]Kim YJ, Kim BH, Yoo SH, et al. Mid-term results of oxford medial unicompartmental knee arthroplasty in young asian patients less than 60 years of age:a minimum 5-year follow-up. Knee Surg Relat Res. 2017;29(2):122-128.
[20]Kuyucu E, Kara A, Say F, et al. Which unicondylar prosthesis is better in the mid-term in obese patients:fixed or mobile?Acta Orthop Belg. 2017;83(4):679-683.
[21]Murray DW, Liddle AD, Dodd CA, et al. Unicompartmental knee arthroplasty:is the glass half full or half empty? Bone Joint J. 2015;97-B(10 Supple A):3-8.
[22]Batailler C, White N, Ranaldi FM, et al. Improved implant position and lower revision rate with robotic-assisted unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2018,doi:10.1007/s00167-018-5081-5.
[23]罗旺林,殷德雄,彭超,等.胫骨高位截骨与单髁置换治疗单室膝骨性关节炎的荟萃分析[J].中国矫形外科杂志, 2018,26(9):814-820.
[24]Kohn L, Sauerschnig M, Iskansar S, et al. Age does not influence the clinical outcome after high tibial osteotomy.Knee Surg Sports Traumatol Arthrosc. 2013;21(1):146-151.
[25]Petersen W, Metzlaff S. Open wedge high tibial osteotomy(HTO)versus mobile bearing unicondylar medial jointreplacement:five years results. Arch Orthop Trauma Surg.2016;136:983-989.
[26]Streit MR, Streit J, Walker T, et al. Minimally invasive Oxford medial unicompartmental knee arthroplasty in young patients.Knee Surg Sports Traumatol Arthrosc. 2017;25(3):660-668.
[27]Faour Martín O, Valverde García JA, Martín Ferrero Má, et al.The young patient and the medial unicompartmental knee replacement. Acta Orthop Belg. 2015;81(2):283-288.
[28]Kleeblad LJ, van der List JP, Zuiderbaan HA, et al. Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65:a systematic review. Knee Surg Sports Traumatol Arthrosc. 2018;26(6):1811-1822.
[29]Carlos Rodríguez-Merchán E, Gómez-Cardero P.Unicompartmental knee arthroplasty:Current indications,technical issues and results. EFORT Open Rev. 2018;3(6):363-373.
[30]Walker T, Streit J, Gotterbarm T, et al. Sports, physical activity and patient-reported outcomes after medial unicompartmental knee arthroplasty in young patients. J Arthroplasty. 2015;30:1911-1916.
[2]Taruc-Uy RL. Diagnosis and treatment of osteoarthritis. Prim Care. 2013;40(4):821-836.
[3]薛浩,刘岩,冉博,等.膝关节骨性关节炎治疗现状[J].医学综述,2018, 24(2):321-325.
[4]Nankaku M, Ito H, Furu M, et al. Preoperative factors related to the ambulatory status at 1 year after total knee arthroplasty.Disabil Rehabil. 2018;40(16):1929-1932.
[5]Ukachukwu V, Duncan R, Belcher J, et al. Clinical significance of medial versus lateral compartment patellofemoral osteoarthritis:cross-sectional analyses in an adult population with knee pain. Arthritis Care Res(Hoboken).2017;69(7):943-951.
[6]徐彬,裴福兴,马俊,等.单髁关节置换术与全膝关节置换术比较治疗单间室骨关节炎疗效的Meta分析[J].中国循证医学杂志,2015,15(6):652-658.
[7]Marmor L. Marmor modular knee in unicompartmental disease:minimum four-year follow-up. J Bone Joint Surg Am.1979;61:347-353.
[8]Goodfellow JW, Kershaw CJ, Benson MK, et al. The Oxford Knee for unicompartmental osteoarthritis:the frst 103 cases.J Bone Joint Surg Br. 1988;70:692-701.
[9]Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am. 1989,71(1):145-150.
[10]白玉明,张海森,刘畅,等.胫骨高位截骨术治疗单纯内侧间室膝骨关节炎术后炎性细胞因子水平变化研究[J].中国修复重建外科杂志,2017,31(4):422-426.
[11]Prodromos CC, Amendola A, Jakob RP, et al. High tibial osteotomy:indications, techniques, and postoperative management. Instr Course Lect. 2015;64:555-565.
[12]Ryu SM, Park JW, Na HD, et al. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis with kissing lesions in relatively young patients.Knee Surg Relat Res. 2018;30(1):17-22.
[13]Yokoyama M, Nakamura Y, Egusa M, et al. Factors related to stress fracture after unicompartmental knee arthroplasty. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2018;1(15):1-5.
[14]Ghomrawi HM, Eggman AA, Pearle AD. Effect of age on cost-effectiveness of unicompartmental knee arthroplasty compared with total knee arthroplasty in the U.S. J Bone Joint Surg Am. 2015; 97(5):396-402.
[15]Ryu SM, Park JW, Na HD, et al. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis with kissing lesions in relatively young patients.Knee Surg Relat Res. 2018;30(1):17-22.
[16]van der List JP, Chawla H, Villa JC, et al. The role of patient characteristics on the choice of unicompartmental versus total knee arthroplasty in patients with medial osteoarthritis. J Arthroplasty. 2016;32(3):761-766.
[17]Kim KT, Lee S, Lee JS, et al. Long-term clinical results of nicompartmental knee arthroplasty in patients younger than60 years of age:minimum 10-year follow-up. Knee Surg Relat Res. 2018;30(1):28-33.
[18]Greco NJ, Lombardi AV Jr, Price AJ, et al. Medial mobile-bearing unicompartmental knee arthroplasty in young patients aged less than or equal to 50 years. J Arthroplasty.2018;33(8):2435-2439.
[19]Kim YJ, Kim BH, Yoo SH, et al. Mid-term results of oxford medial unicompartmental knee arthroplasty in young asian patients less than 60 years of age:a minimum 5-year follow-up. Knee Surg Relat Res. 2017;29(2):122-128.
[20]Kuyucu E, Kara A, Say F, et al. Which unicondylar prosthesis is better in the mid-term in obese patients:fixed or mobile?Acta Orthop Belg. 2017;83(4):679-683.
[21]Murray DW, Liddle AD, Dodd CA, et al. Unicompartmental knee arthroplasty:is the glass half full or half empty? Bone Joint J. 2015;97-B(10 Supple A):3-8.
[22]Batailler C, White N, Ranaldi FM, et al. Improved implant position and lower revision rate with robotic-assisted unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2018,doi:10.1007/s00167-018-5081-5.
[23]罗旺林,殷德雄,彭超,等.胫骨高位截骨与单髁置换治疗单室膝骨性关节炎的荟萃分析[J].中国矫形外科杂志, 2018,26(9):814-820.
[24]Kohn L, Sauerschnig M, Iskansar S, et al. Age does not influence the clinical outcome after high tibial osteotomy.Knee Surg Sports Traumatol Arthrosc. 2013;21(1):146-151.
[25]Petersen W, Metzlaff S. Open wedge high tibial osteotomy(HTO)versus mobile bearing unicondylar medial jointreplacement:five years results. Arch Orthop Trauma Surg.2016;136:983-989.
[26]Streit MR, Streit J, Walker T, et al. Minimally invasive Oxford medial unicompartmental knee arthroplasty in young patients.Knee Surg Sports Traumatol Arthrosc. 2017;25(3):660-668.
[27]Faour Martín O, Valverde García JA, Martín Ferrero Má, et al.The young patient and the medial unicompartmental knee replacement. Acta Orthop Belg. 2015;81(2):283-288.
[28]Kleeblad LJ, van der List JP, Zuiderbaan HA, et al. Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65:a systematic review. Knee Surg Sports Traumatol Arthrosc. 2018;26(6):1811-1822.
[29]Carlos Rodríguez-Merchán E, Gómez-Cardero P.Unicompartmental knee arthroplasty:Current indications,technical issues and results. EFORT Open Rev. 2018;3(6):363-373.
[30]Walker T, Streit J, Gotterbarm T, et al. Sports, physical activity and patient-reported outcomes after medial unicompartmental knee arthroplasty in young patients. J Arthroplasty. 2015;30:1911-1916.
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