膝外侧室骨性关节炎的特点与单髁置换术

Characteristics of isolated lateral unicompartmental knee arthritis and unicompartmental knee arthroplasy

摘要:

目的：比较膝外侧单髁置换术（unicompartmental knee arthroplasty,UKA）在治疗外侧半月板切除后继发性膝骨性关节炎与原发性骨性关节炎的中期临床疗效。 方法：回顾性分析2013年3月-2019年3月因膝外侧室骨性关节炎行初次外侧UKA 327例患者临床资料，根据是否有半月板切除史，将患者分为2组：继发组（半月板切除组）38例，按照年龄、性别及术肢侧别进行1:1配对，选择38例纳入原发组（无半月板切除组）。比较两组患者的一般资料、围手术期、临床随访与影像学资料等。 结果： 继发组术前的Q角和膝外侧室重度骨关节炎比例均显著高于原发组，而膝关节屈曲挛缩角度显著低于原发组（p＜0.05）。继发组中男性在半月板切除后的无症状生存率显著大于女性（p＞0.05）。所有患者平均随访（63.2±24.6）个月。两组间术前及术后末次随访的VAS、OKS评分、ROM、股胫角（FTA）、胫骨近端内侧角（MPTA）和胫骨外侧平台后倾角（PTSA）、手术时间和手术切口总长度等比较均无统计学意义（p＞0.05）。原发组发生术后切口浅表皮肤感染一例，两组均无翻修病例。 结论：外侧UKA治疗膝外侧室骨性关节炎术后中期临床疗效满意。外侧半月板切除史对于外侧UKA的术后疗效影响不显著。

Abstract:

Objective To compare the mid-term follow-up outcomes of lateral unicompartmental knee arthroplasty (UKA) in the treatment of secondary knee arthritis after lateral meniscectomy with primary arthritis. Methods The clinical data of 327 patients who underwent lateral UKA for lateral unicompartmental knee arthritis from March 2013 to March 2019 were retrospectively analyzed, and the patients were finally divided into 2 groups according to whether they had a history of previous meniscectomy or not: 38 patients in the secondary group (post-meniscectomy group), and 38 patients were selected as the primary group (without meniscectomy group) by a 1:1 matching according to age, sex, and side of the operated limb. Compared the general data, perioperative period, clinical follow-up outcomes and imaging data of the two groups of patients. Results Preoperative Q-angle of patients in the secondary group was significantly higher than that in the primary group, as well as the proportion of severe osteoarthritis of the lateral unicompartment knee (K-L classification grade 4) (p < 0.05). Whereas the angle of knee flexion contracture was significantly lower than that in the primary group (p < 0.05). Men had a significantly greater post-meniscectomy asymptomatic survival rate than women in the secondary group (p > 0.05). All patients were followed up for a mean of (63.2 ± 24.6) months. There were not statistically significant differences in the preoperative and postoperative scores of VAS, OKS, ROM, femorotibial angle (FTA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), operation time, and the duration of surgery between the two groups. During the follow-up period, there was 1 case of superficial incision infection in the primary group. There were no revision cases in both groups. Conclusion The mid-term follow-up outcomes of lateral UKA for the treatment of lateral unicompartmental knee arthritis were reliable. History of lateral meniscectomy did not exert a significant negative effect on lateral UKA for the treatment of lateral unicompartmental knee arthritis.