牛津单髁膝置换三种胫骨旋转定位技术比较

Comparison of three tibial rotation positioning techniques in Oxford unicompartmental arthroplasty

摘要:

[目的] 比较牛津单髁置换术三种胫骨旋转定位方法的临床结果。[方法] 2018 年 1 月—2020 年 1 月膝关节内侧间室骨关节炎患者 59 例，随机分为三组，均行牛津单髁置换术。其中，19 例采用髂前上棘定位 (anterior superior iliac spine, ASIS)；20 例采用替代前后线法 (substitute anteroposterior line, sAP)，20 例采用胫骨解剖轴定位 (anatomical tibial axis, ATA)。 比较三组围手术期、随访及影像资料。[结果]所有患者均顺利完成手术，三组患者手术时间、切口长度、术中失血量、下地时间、住院时间、切口愈合方面的差异均无统计学意义(P＞0.05)。术中见 ASIS 组中 5 例(26.32%)患者膝关节伸直时聚乙烯垫块突出到金属托之外，平均突出距离为 (2.07±0.52) mm。而 sAP 组中为 2 例 (10.00%)，平均突出距离为 (1.93±0.38) mm。ATA 组中无聚乙烯垫块突出病例。随访时间平均 (14.82±1.05) 个月，术后随时间推移，三组患者 KSS 临床评分和功能评分均显著增加 (P＜0.05)，术后 1 个月三组患者 VAS、KSS 临床评分和功能评分均显著优于术前，差异有统计学意义 (P＜ 0.05)。术后 12 个月，sAP 组和 ATA 组的 KSS 临床评分均显著优于 ASIS 组 (P＜0.05)，sAP 组与 ATA 组的 KSS 功能评分及 VAS 比较，差异无统计学意义 (P＞0.05)。影像方面，末次随访时，ASIS 组的平均外旋角度显著大于 sAP 组和 ATA 组 (P＜ 0.05)。随访期间无假体脱位、松动病例。[结论]牛津单髁置换术中 sAP 线和胫骨解剖轴线定位胫骨假体外旋，操作简单、可重复性高，有利于术后关节功能的恢复。

Abstract:

[Objective] To compare the clinical outcomes of three tibial rotation positioning techniques in Oxford unicompartmental ar- throplasty (UKA) . [Methods] From January 2018 to January 2020, 59 patients with medial compartment osteoarthritis of the knee were en- rolled into this study and were randomly divided into three groups. All the patients received UKA, with tibial rotation positioning by anteri- or superior iliac spine (ASIS) in 19 patients, substitute anteroposterior line (sAP) in 20 patients, and anatomical tibial axis (ATA) in 20 pa- tients. The 3 groups were compared regarding to perioperative, follow-up and radiographic documents. [Results] All the patients in the 3 groups had UKA performed smoothly without serious complications. Although there were no significant differences in terms of operation time, incision length, intraoperative blood loss, time to resume walking, hospital stay and incision healing among the 3 group (P＞0.05) , the anteromedial protrusion of the liner was noted in 5 cases of ASIS with a displacement of (2.07±0.52) mm , whereas 2 cases in the sAP group with a displacement of (1.93±0.38) mm, and none of the ATA group, which proved statistically significant (P＜0.05) . As time went during the follow-up lasted for (14.82±1.05) months on average, the KSS clinical and functional scores significantly increased in all the 3 groups (P＜0.05) . Although there were no statistically significant differences in preoperative KSS clinical score and functional score among the three groups (P＞0.05) , the sAP group and ATA group was significantly superior to the ASIS group in KSS clinical score at 12 months post- operatively (P＜0.05) . Radiographically, the ASIS group had significantly greater external rotation angle of the tibial component than the sAP group and the ATA group postoperatively (P＜0.05) . No dislocation or loosening of the prosthesis was found in anyone of the 3 groups during follow-up. [Conclusion] The external rotation of tibial prosthesis positioning by sAP line and tibial anatomical axis in Oxford UKA is simple and reproducible, which is beneficial to the recovery of postoperative joint function.