摘要
目的了解单间室膝关节置换治疗骨关节炎及骨坏死的近期疗效,探讨其手术适应证及手术要点。方法自1999年4月～2000年7月对20例患者行单间室膝关节置换术,男10例(12膝),女10例(12膝);其中骨关节炎18例(22膝),骨坏死2例(2膝);术后随访13～34个月,平均25.7个月。随访主要指标为站立位下肢胫股角(femorotibialangle,FTA)、膝关节伸屈活动度及JOA(日本骨科学会)膝关节功能评分。结果术后平均FTA与术前相比差异有非常显著性意义(P<0.001)。随访时24膝平均活动度与术前相比差异有显著性意义,关节屈曲挛缩得到明显改善(P=0.0025);随访时屈曲度与术前相比差异无显著性,而术前与术后的屈曲度相关性分析显示两者间差异有非常显著性意义(r=0.742,P<0.001)。结论单间室膝关节置换术具有手术创伤小、活动度恢复好的优点,近期效果相当满意。严格掌握手术指征是手术成功的关键,同时对手术技术及手术经验也有较高要求,中远期效果有待进一步随访。
Objective To report the short-term result of unicompartmental knee arthroplasty (UKA) for osteoarthritis and spontaneous osteonecrosis of the knee, and discuss the indications and surgical pitfalls for the procedure as well. Methods From April 1999 to July 2000, unicompartmental knee arthroplasty were performed in 20 cases (24 knees). Osteoarthritis in 18 cases (20 knees) and spontaneous osteonecrosis in 2 cases (2 knees); 10 males (12 knees) and 10 females (12 knees). The range of motion (ROM), femorotibial angle (FTA) and JOA score were adopted as main parameters to evaluate the outcome of the operation. The mean age of the patients at the time of operation was 73.3±7.1 years,and 75.0±6.8 years at the final follow-up. The mean follow-up period was 25.7±15.0 months. The prostheses used in the group were unicompartment sleigh shaped artificial joint of Link Endomodel Sled Knee, Waldemar Link or YCMK. Results Before operation, the mean ROM was from 5.4°±6.1°(extension) to 120.0°±15.0°(flexion), the flexion deformity was significantly corrected after operation. The average extension was 2.1°±2.5° at the time of follow-up, significantly improved comparing with 5.4°±6.1° of pre-operation (P<0.01). On the other hand, the flexion of the knees movement was well preserved (average equally to that of the preoperative) and flexion deformity was significantly corrected (P=0.002 5). A strong correlation was found between the degree of pre-operative flexion and that measured at final follow-up (r=0.742, P<0.001). The axial alignment was also changed into normal range with the average FTA of 175.5°±2.4° at follow-up. The JOA scores was significantly increased from preoperative 56.7±9.9 to 91.3±8.1 at the time of follow-up. Conclusion Unicompartmental knee arthroplasty is an effective management for osteoarthritis and osteonecrosis of the knee, it is less invasive and ideal for recovery of ROM. This is only true when the surgeon is well experienced and the patient is strictly indicated.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第2期69-72,共4页
Chinese Journal of Orthopaedics
