运动对线单髁膝置换的临床与影像研究

Clinical outcome and radiographic assessment of Oxford mobile bearing UKA by using kinematic alignment technique

摘要:

［目的］比较单髁关节置换运动学对线定位技术与传统手术技术，在术中垫片运动轨迹、临床效果和影像学评价上的差异。［方法］回顾性分析 2019 年 1—6 月收治牛津单髁手术患者。其中，23 例（30 膝）术中采用运动学对线技术（运动学组），另外 25 例（30 膝）术中采用常规对线技术（常规组），两组患者一般资料差异无统计学意义（P>0.05）。比较两组术中垫片运动方式和运动距离、临床效果及影像学资料。［结果］术中垫片运动轨迹存在差异，运动组可达到更为理想的垫片运动轨迹（P<0.05），而术中垫片移动距离差异无统计学意义（P>0.05）。临床结果显示，运动组手术时间和出血量均显著少于常规组（P<0.05）。相应时间点， 两组间 KSS 评分差异均无统计学意义（P>0.05）。影像评估显示，两组患者术后的髋膝踝角（hip-knee-ankle angle, HKAA）均较术前显著增加（P<0.05），相应时间点两组间 HKAA 的差异均无统计学意义（P>0.05）。术后两组间股骨及胫骨假体内外翻、股骨假体屈伸、胫骨假体后倾、假体相对倾斜角比较差异均无统计学意义（P>0.05）。但是，运动组的假体邻近度显著小于常规组（P<0.05）。［结论］本研究中介绍的膝关节单髁置换术（unicompartmental knee arthroplasty, UKA）中运动学对线定位技术与传统手术相比，临床效果相似，假体安装准确性相似，但手术时间更短、术中出血量更小、假体间的邻近度更小，且垫片运动轨迹更为理想。

Abstract:

[Objective] To clarify whether the kinematic alignment technique improve the trajectory of the bearing movement, as well as the clinical outcomes and radiological presentations in Oxford mobile bearing unicompartmental knee arthroplasty (Oxford MB UKA) . [Methods] We retrospectively analyzed the patients who underwent UKA from January to June, 2019. Of them, 23 patients (30 knees) had UKA performed by the kinematic alignment technique (the kinematic group) , while the other 25 patients (30 knees) received UKA with the conventional alignment technique (the conventional group) . There were no significant differences in term of baseline data preoperatively be- tween the two groups. The intraoperative bearing movement mode, motion distance, clinical outcome and radiographic data were compared between the two groups. [Results] The kinematic group proved significantly superior to the conventional group in term of bearing movement trajectory (P＜0.05) , despite of the fact that no a difference was noticed in the motion distance of the liner between them (P＞0.05) . In terms of clinical outcomes, the kinematic group was significantly superior to the conventional group regarding to intraoperative blood loss and oper- ation time (P＜0.05) , whereas there were no statistically significant differences in KSS clinical and functional scores between the two groups at any matching time point (P＞0.05) . Radiographically, the hip- knee- ankle angle (HKAA) significantly decreased postoperatively com- pared with that preoperatively in both groups (P＜0.05) , which was not statistically different between the two groups at any corresponding time point (P＞0.05) . There were no significant differences in terms of varus-valgus angles of the femoral and tibial components, flexion-ex- tension angle of the femoral component, posterior slope of the tibial tray and relative oblique of the femoral and tibial components between the two groups (P＞0.05) . However, the kinematic group got significantly closer contiguity of the components than the conventional group (P＜ 0.05) . [Conclusion] Although the kinematic technique does achieve similar prosthetic installation accuracy and clinical outcome with the conventional technique for Oxford MB UKA, the former has advantages of less blood loss, shorter operation time, closer contiguity of the fem- oral and tibial components, and more optimal bearing movement trajectory over the latter.