膝关节活动平台单髁置换中期并发症分析△

An analysis on mid- term complications of mobile- bearing medial unicompartmental knee arthroplasty

摘要:

[目的] 探讨膝关节单髁表面置换活动平台假体术后中期并发症特点及相关处理措施。[方法] 回顾性分析 2008 年 8 月—2020 年 8 月于本科行膝关节单髁表面置换术 313 例患者(373 膝)的临床资料，随访评价膝关节单髁表面置换术后临床疗效，并对术后并发症进行分析。[结果] 所有患者均获随访，随访时间 12~132 个月，平均 (84.68±12.12) 个月。随时间推移，患者术后 VAS 评分显著减少(P＜0.05)，而 KSS 临床评分、KSS 功能评分和 ROM 显著增加(P＜0.05)。影像方面，术前至末次随访时，外侧室 K-L 评级无显著改变 (P＞0.05)。并发症方面，在 313 例患者中，共有 22 例 (7.03%) 出现术后并发症。 其中，男性 3 例 (13.64%)，女性 19 例 (86.36%)。按并发症发生的频次由高至低依次为：聚乙烯衬垫脱位 12 例 (3.83%)， 弹响 4 例 (1.28%)，疼痛 4 例 (1.28%)，假体松动 1 例 (0.32%)，切口并发症 1 例 (0.32%)。至末次随访时，5 例 (5 膝)， 包括 4 膝聚乙烯衬垫脱位，1 膝假体松动接受了 TKA 翻修，占患者总数的 1.34%。[结论] 活动平台单髁假体术后导致手术失败的主要并发症为聚乙烯衬垫脱位，应引起重视。

Abstract:

[Objective] To explore the characteristics and related management measures of mid-term complications of mobile-bearing medial unicompartmental knee arthroplasty (UKA) . [Methods] A retrospective study was conducted on 313 patients (373 knees) who un- derwent UKA for medial knee osteoarthritis in our department from August 2008 to August 2020. The clinical efficacy was evaluated, while complications in mid-term were analyzed. [Results] All patients were followed up for 12~132 months, with an average of (84.68±12.12) months. The VAS scores decreased significantly (P＜0.05) , whereas the KSS clinical score and functional score, as well as knee flexion range of motion (ROM) significantly increased over time postoperatively (P＜0.05) . Radiographically, there was no significant change in term of the lateral compartment Kellgren-Lawrence classification from the time point preoperatively to the latest follow-up (P＞0.05) . In terms of complications, 22 cases (7.03%) of the 313 patients developed postoperative complications, including 3 males (13.64%) and 19 fe- males (86.36%) . In term of frequency of complications up-down, polyethylene liner dislocation was noted in 12 cases (3.83%) , snapping was in 4 cases (1.28%) , pain was found in 4 cases (1.28%) , aseptic loosening was in 1 case (0.32%) and incision complication was in 1 case (0.32%) . By the time of the latest follow-up, 5 patients (5 knees) , including 4 knees of bearing dislocation and 1 knee of prosthesis loosening, received revision total knee arthroplasty, accounting for 1.34% of the total patients. [Conclusion] The main complication leading to failure of mobile-bearing medial unicompartmental knee arthroplasty is bearing dislocation, which should be paid more attention to.