人工内侧单髁置换对膝关节伸屈过程中胫骨轴向旋转的影响
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摘要
目的:
1,探讨总结人工单髁置换治疗膝关节内侧胫股间隙骨性关节炎的手术适应症、手术方法和近期疗效;
2,探讨采用CT三维成像观察研究人工关节置换前后胫骨轴向旋转的可行性;
3,观察人工内侧单髁置换对膝关节伸屈过程中胫骨轴向旋转的影响。
方法:
对我院自2004年12月~2005年9月采用人工单髁置换术治疗17例膝关节内侧胫股间隙骨性关节炎的适应症、手术方法、术后处理及疗效进行总结和随访。
正常膝关节成人志愿者5人,年龄20~40岁,共10个膝关节。采用螺旋CT三维成像技术,通过膝关节伸曲过程中股骨内外侧髁旋转轴心相对胫骨平台的前后移位,测量正常非负重膝关节伸屈过程中胫骨轴向不随意旋转。
人工单髁置换治疗单室膝关节骨性关节炎10例,10个膝关节,术后时间8~18个月。采用螺旋CT三维成像技术,观察人工单髁置换术患者非负重膝关节伸屈过程中胫骨轴向旋转的方式,并与正常人胫骨轴向旋转进行比较。
结果:
17例均获随访,无感染、假体位置不良及松动等并发症。HSS评分由术前73分提高至术后96分,平均关节活动范围:0°~125?。
正常成人5人,10个膝关节;CT三维重建测量结果:0°～120°屈曲过程中胫骨平均轴向内旋18.7°±1.5°,其中0°～30°、30°～60°、60°～90°和90°～120°屈曲时,胫骨分别平均内旋4.1°±1.2°、2.1°±1.2°、3°±2.1°和9.5°±1.6°。
人工单髁置换治疗单室膝关节骨性关节炎10例,10个膝关节,术后时间8~18个月;0°～90°屈曲过程中胫骨平均轴向内旋9.6°±1.4°,其中0°～30°、30°～60°和60°～90°屈曲时,胫骨分别平均内旋4.2°±1.2°、2.2°±1.6°和3.2°±1.5°。两组膝关节在0°～30°、30°～60°和60°～90°屈曲时胫骨平均内旋无统计学差异(配对T检验,P>0.5)。
结论:
1,人工单髁置换治疗膝关节单侧胫股间隙骨性关节炎近期疗效优良,成功的关键在于适应症把握和手术技术,其远期疗效仍需观察;15°~20°内翻并非UKA的禁忌症;小于6mm胫股关节半脱位,施行UKA是安全的。
2,CT三维重建可以作为一种研究人工关节置换前后胫骨轴向旋转的手段;
3,人工内侧单髁置换不改变膝关节伸屈过程中胫骨轴向旋转,是单髁置换后屈曲活动度恢复好的原因之一。
Objective: To study result of unicondylar arthroplasty for the treatment of medialcompartmental osteoarthritis of knee. To validate the credibility of the measure of the tibiallongitudinal rotation during flexion with CT three-dimensional imaging,and to ivestigatethe tibial longitudinal rotation during flexion after medial unicondylar arthroplasty.
Methods: Seventeen patients with medial compartmental osteoarthritis of knee had beentreated by unicondylar arthroplasty from Dec,2004 toSep,2005..Patient selection,surgicaltechnique,postoperational treatment and short-term results were analyzed. Ten normalknees from five adults and ten patients with unilateral medial compartmental osteoarthritisof knee had been treated by unicondylar arthroplasty were included,their tibial longitudinalrotation during flexion were measured with CT three-dimensional imaging,The results ofthe two groups were intercompared.
Results: .All of the patients got followed up .Had no any complication.Average HSS scorewas 96. Ten normal knees flexed at 30°、60°、90°and 120°position,tibia average internalrotated 4.1°+1.2°、2.1°+1.2°、3°+2.1°and 9.5°+1.6°respectively,was the same to the resultsof literatrues.Ten knees after UKA flexed at 30°、60°and 90°position,tibia average internalrotated 4.2°+1.2°、2.2°+1.6°and 3.2°+1.5°respectively.Compared the results of the two groups with Paired-Samples T Test,flexed at 30°、60°and 90°position respectively, thedegrees of tibial average internal rotation have no different(P>0.5).
Conclusion: The short-term result of unicondylar arthroplasty for unicompartmentalosteoarthritis of knee is excellent. Patient selection and surgical technique are the mostimportant factors affecting the final result. 15°~20°varus of the knee is not contraindicationto UKA.If the later subluxation is lesser than 6mm,it can be corrected by UKA.CTthree-dimensional imaging is a effectual method to ivestigate the tibial longitudinal rotationduring flexion,especially after arthroplasty.Medial UKA has no effect on the tibiallongitudinal rotation during flexion.
1,探讨总结人工单髁置换治疗膝关节内侧胫股间隙骨性关节炎的手术适应症、手术方法和近期疗效;
2,探讨采用CT三维成像观察研究人工关节置换前后胫骨轴向旋转的可行性;
3,观察人工内侧单髁置换对膝关节伸屈过程中胫骨轴向旋转的影响。
方法:
对我院自2004年12月~2005年9月采用人工单髁置换术治疗17例膝关节内侧胫股间隙骨性关节炎的适应症、手术方法、术后处理及疗效进行总结和随访。
正常膝关节成人志愿者5人,年龄20~40岁,共10个膝关节。采用螺旋CT三维成像技术,通过膝关节伸曲过程中股骨内外侧髁旋转轴心相对胫骨平台的前后移位,测量正常非负重膝关节伸屈过程中胫骨轴向不随意旋转。
人工单髁置换治疗单室膝关节骨性关节炎10例,10个膝关节,术后时间8~18个月。采用螺旋CT三维成像技术,观察人工单髁置换术患者非负重膝关节伸屈过程中胫骨轴向旋转的方式,并与正常人胫骨轴向旋转进行比较。
结果:
17例均获随访,无感染、假体位置不良及松动等并发症。HSS评分由术前73分提高至术后96分,平均关节活动范围:0°~125?。
正常成人5人,10个膝关节;CT三维重建测量结果:0°～120°屈曲过程中胫骨平均轴向内旋18.7°±1.5°,其中0°～30°、30°～60°、60°～90°和90°～120°屈曲时,胫骨分别平均内旋4.1°±1.2°、2.1°±1.2°、3°±2.1°和9.5°±1.6°。
人工单髁置换治疗单室膝关节骨性关节炎10例,10个膝关节,术后时间8~18个月;0°～90°屈曲过程中胫骨平均轴向内旋9.6°±1.4°,其中0°～30°、30°～60°和60°～90°屈曲时,胫骨分别平均内旋4.2°±1.2°、2.2°±1.6°和3.2°±1.5°。两组膝关节在0°～30°、30°～60°和60°～90°屈曲时胫骨平均内旋无统计学差异(配对T检验,P>0.5)。
结论:
1,人工单髁置换治疗膝关节单侧胫股间隙骨性关节炎近期疗效优良,成功的关键在于适应症把握和手术技术,其远期疗效仍需观察;15°~20°内翻并非UKA的禁忌症;小于6mm胫股关节半脱位,施行UKA是安全的。
2,CT三维重建可以作为一种研究人工关节置换前后胫骨轴向旋转的手段;
3,人工内侧单髁置换不改变膝关节伸屈过程中胫骨轴向旋转,是单髁置换后屈曲活动度恢复好的原因之一。
Objective: To study result of unicondylar arthroplasty for the treatment of medialcompartmental osteoarthritis of knee. To validate the credibility of the measure of the tibiallongitudinal rotation during flexion with CT three-dimensional imaging,and to ivestigatethe tibial longitudinal rotation during flexion after medial unicondylar arthroplasty.
Methods: Seventeen patients with medial compartmental osteoarthritis of knee had beentreated by unicondylar arthroplasty from Dec,2004 toSep,2005..Patient selection,surgicaltechnique,postoperational treatment and short-term results were analyzed. Ten normalknees from five adults and ten patients with unilateral medial compartmental osteoarthritisof knee had been treated by unicondylar arthroplasty were included,their tibial longitudinalrotation during flexion were measured with CT three-dimensional imaging,The results ofthe two groups were intercompared.
Results: .All of the patients got followed up .Had no any complication.Average HSS scorewas 96. Ten normal knees flexed at 30°、60°、90°and 120°position,tibia average internalrotated 4.1°+1.2°、2.1°+1.2°、3°+2.1°and 9.5°+1.6°respectively,was the same to the resultsof literatrues.Ten knees after UKA flexed at 30°、60°and 90°position,tibia average internalrotated 4.2°+1.2°、2.2°+1.6°and 3.2°+1.5°respectively.Compared the results of the two groups with Paired-Samples T Test,flexed at 30°、60°and 90°position respectively, thedegrees of tibial average internal rotation have no different(P>0.5).
Conclusion: The short-term result of unicondylar arthroplasty for unicompartmentalosteoarthritis of knee is excellent. Patient selection and surgical technique are the mostimportant factors affecting the final result. 15°~20°varus of the knee is not contraindicationto UKA.If the later subluxation is lesser than 6mm,it can be corrected by UKA.CTthree-dimensional imaging is a effectual method to ivestigate the tibial longitudinal rotationduring flexion,especially after arthroplasty.Medial UKA has no effect on the tibiallongitudinal rotation during flexion.
引文
1. Peter F.Sharkery :Unicompartmental Knee Arthroplasty,American Academy of Orthopaedic Surgeons 2004 Annual Meeting , Proceedings volume 5, 106.
2. Insall JN,Walker PS:Uncondylar knee replacement.Clin Orthop 120:83,1976
3. Laskin RS. Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg Am 60:182,1978.
4. Berger RA,Nedeff DD,Bardeh RM,et al:Unicompartmental knee arthroplasty. Clin Orthop.1999;367:50-60.
5. Gunther T,Marray DW,Mfiller R et al. Lateral unicompartmental arthroplaty with Oxford meniscal knee..The Knee, 1996; 3(1): 33- 39
6. ozinn SC,Scott RD:Current concepts review:Unicompartmental total arthroplasty.J Bone Joint Surg Am 71:145,1989.
7. Rougraff BT,Heck DA,Gibson AE:A comparison of tricompartmental and unicompartmental arthroplasty for the treatment of gonarthrosis .Clin Orthop 273: 157, 1991.
8. Thornhill TS,Scott RD:Unicompartmental total knee arthroplasty.Clin Orthop 20:25,1989.)
9.张卫国,夏仁云,杨华清等.微创人工单髁置换治疗膝关节内侧胫股间隙骨性关节炎.中国骨与关节损伤杂志,2006,21(10):79
10. JN.Insall,WN.Scott.Surgery of the Knee.3rd ed.Philadelphia: Churchill Livingstone,2001.259-283
11. akagawa S,Kadoya Y,Todo S,et al. Tibiofemaal movement 3: full flexion in the living knee studied by MRI. J Bone Jant Surg (Br),2000. 82:1199-1200
12. omistek R, Dannis D,Walker S,et al : In vivo analysis of tibiofemoral rotation:Does screwhome roration occur after TKA? Annual Meeting of the AAOS,New Orleans,LA,1998.
13.王晓峰,陈百成,高石军等不同类型假体全膝关节置换术后的运动学分析,中华骨科杂志,2004,24(8):495~498
1. Peter F.Sharkery :Unicompartmental Knee Arthroplasty,American Academy of Orthopaedic Surgeons 2004 Annual Meeting ,Proceedings volume 5,106.
2. Tria AJ Jr: Unicondylar Knee Arthroplasty-The MIS Technique, American Academy of Orthopaedic Surgeons 2004 Annual Meeting ,Proceedings volume 5,104-105.
3. Marmor L, Unicompartmental knee arthroplasty,ten to thirteen years follow up study.Clin Orthop 1987;226:14-20.
4. Romanowski MR,Repicci JA:Minimally invasive unicondylar arthroplasty. Eight-year-follow-up.J Knee Surg.2002;15:17-22.
5. Berger RA,Nedeff DD,Bardeh RM,et al:Unicompartmental knee arthroplasty. Clin Orthop.1999;367:50-60.
6.吕厚山主编,人工关节外科,北京,科学出版社,1998年10月,401
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1.周一新,蒋毅,张洪等.胫骨轴向旋转运动与膝关节屈伸运动藕合的研究.中华骨科杂志,2004,24(12):747
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1周一新,蒋毅,张洪等.胫骨轴向旋转运动与膝关节屈伸运动藕合的研究.中华骨科杂志,2004,24(12):747
2 JN.Insall,WN.Scott.Surgery of the Knee.3rd ed.Philadelphia:Churchill Livingstone, 2001.259-283
3张卫国,夏仁云,杨华清等.微创人工单髁置换治疗膝关节内侧胫股间隙骨性关节炎.中国骨与关节损伤杂志,2006,21(10):791
4 Romanowski MR,Repicci JA:Minimally invasive unicondylar arthroplasty. Eight-year-follow-up.J Knee Surg.2002;15:17-22.
5 Nakagawa S,Kadoya Y,Todo S,et al. Tibiofemaal movement 3: full flexion in the living knee studied by MRI. J Bone Jant Surg (Br),2000.82:1199-1200
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19.王晓峰,陈百成,高石军等不同类型假体全膝关节置换术后的运动学分析,中华骨科杂志,2004,24(8):495~498
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1. Marmor L, Unicompartmental knee arthroplasty,ten to thirteen years follow up study.Clin Orthop 1987;226:14-20.
2. Romanowski MR,Repicci JA:Minimally invasive unicondylar arthroplasty. Eight-year-follow-up.J Knee Surg.2002;15:17-22.
3. Berger RA,Nedeff DD,Bardeh RM,et al:Unicompartmental knee arthroplasty. Clin Orthop.1999;367:50-60.
4. Peter F.Sharkery :Unicompartmental Knee Arthroplasty,American Academy of Orthopaedic Surgeons 2004 Annual Meeting ,Proceedings volume 5,106.
5. Insall JN,Walker PS:Uncondylar knee replacement.Clin Orthop 120:83,1976
6. Laskin RS. Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg Am 60:182,1978.
7. Newman JH, Ackroyd CE,Shah NS.Unicompartmental or total knee replacement? The 5 year result of a prospective randomized teial of 102 osteoarthritic knees with unicompartmental arthritis .J Bone Joint Surg Br, 1998; 80(5):862- 865
8. Gunther T,Marray DW,Mfiller R et al. Lateral unicompartmental arthroplaty with Oxford meniscal knee..The Knee, 1996; 3(1):33-39
9. Kozinn SC,Scott RD:Current concepts review:Unicompartmental total arthroplasty.J Bone Joint Surg Am 71:145,1989.
10. Rougraff BT,Heck DA,Gibson AE:A comparison of tricompartmental andunicompartmental arthroplasty for the treatment of gonarthrosis .Clin Orthop 273:157,1991.
11. Thornhill TS,Scott RD:Unicompartmental total knee arthroplasty.Clin Orthop 20:25,1989.)
12.张卫国,夏仁云,杨华清等.微创人工单髁置换治疗膝关节内侧胫股间隙骨性关节炎.中国骨与关节损伤杂志,2006,21(10):79
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22.吕厚山主编,人工关节外科,北京,科学出版社,1998年10月,401
2. Insall JN,Walker PS:Uncondylar knee replacement.Clin Orthop 120:83,1976
3. Laskin RS. Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg Am 60:182,1978.
4. Berger RA,Nedeff DD,Bardeh RM,et al:Unicompartmental knee arthroplasty. Clin Orthop.1999;367:50-60.
5. Gunther T,Marray DW,Mfiller R et al. Lateral unicompartmental arthroplaty with Oxford meniscal knee..The Knee, 1996; 3(1): 33- 39
6. ozinn SC,Scott RD:Current concepts review:Unicompartmental total arthroplasty.J Bone Joint Surg Am 71:145,1989.
7. Rougraff BT,Heck DA,Gibson AE:A comparison of tricompartmental and unicompartmental arthroplasty for the treatment of gonarthrosis .Clin Orthop 273: 157, 1991.
8. Thornhill TS,Scott RD:Unicompartmental total knee arthroplasty.Clin Orthop 20:25,1989.)
9.张卫国,夏仁云,杨华清等.微创人工单髁置换治疗膝关节内侧胫股间隙骨性关节炎.中国骨与关节损伤杂志,2006,21(10):79
10. JN.Insall,WN.Scott.Surgery of the Knee.3rd ed.Philadelphia: Churchill Livingstone,2001.259-283
11. akagawa S,Kadoya Y,Todo S,et al. Tibiofemaal movement 3: full flexion in the living knee studied by MRI. J Bone Jant Surg (Br),2000. 82:1199-1200
12. omistek R, Dannis D,Walker S,et al : In vivo analysis of tibiofemoral rotation:Does screwhome roration occur after TKA? Annual Meeting of the AAOS,New Orleans,LA,1998.
13.王晓峰,陈百成,高石军等不同类型假体全膝关节置换术后的运动学分析,中华骨科杂志,2004,24(8):495~498
1. Peter F.Sharkery :Unicompartmental Knee Arthroplasty,American Academy of Orthopaedic Surgeons 2004 Annual Meeting ,Proceedings volume 5,106.
2. Tria AJ Jr: Unicondylar Knee Arthroplasty-The MIS Technique, American Academy of Orthopaedic Surgeons 2004 Annual Meeting ,Proceedings volume 5,104-105.
3. Marmor L, Unicompartmental knee arthroplasty,ten to thirteen years follow up study.Clin Orthop 1987;226:14-20.
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