膝外侧室骨性关节炎的特点与单髁置换术△（开放获取）

Characteristics of osteoarthritis involving knee lateral compartment and unicompartmental knee arthroplasty（OA）

摘要:

[目的]比较膝外侧单髁置换术（unicompartmental knee arthroplasty, UKA）治疗外侧半月板切除后继发性膝骨性关节炎 （post-meniscectomy knee osteoarthritis, PMKO） 与原发性膝骨性关节炎 （primary knee osteoarthritis, PKOA） 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，将患者分为两组：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。[结果]继发组外伤史的比率 [(例, 有/ 无), (36/2) vs (0/38), P＜0.001]，术前 Q 角 [(15.3±3.0)° vs (12.8±3.3)°, P＜0.001]，术前外侧室 Kellgren-Lawrence (K-L) 分级的严重程度 [ 0/1/2/3/4, (0/0/1/13/24) vs (0/0/3/21/14), P=0.020] 均显著大于原发组，而术前膝关节屈曲挛缩角度 [(5.6±3.9)° vs (8.2±4.5)°, P=0.014] 显著小于原发组。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）。两组手术时间、切口总长度、术中失血量、术后引流量、切口愈合和住院时间比较，差异均无统计学意义（P＞0.05）。所有患者平均随访（63.2±24.6）个月，随访过程中两组均无翻修病例。两组末次随访 VAS、OKS 评分、ROM、股胫角、胫骨近端内侧角和胫骨外侧平台后倾角的差异均无统计学意义（P＞0.05）。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 clinical outcomes of lateral unicompartmental knee arthroplasty (UKA) in the treatment of post-meniscectomy knee osteoarthritis (PMKO) versus primary knee osteoarthritis (PKOA). [Methods] A retrospective analysis was conducted on 327 patients who underwent initial lateral UKA due to osteoarthritis of the lateral compartment from March 2013 to March 2019. Based on whether they had a history of meniscectomy, the patients were divided into two groups. Of them, 38 patients were fall in the PMKO group (meniscectomy group), subsequently, 38 patients were selected to be included in the PKOA group (non-meniscectomy group) by paired 1∶1 according to age, gender, and side affected. The documents were compared between the two groups regarding to general information, perioperative period, clinical follow-up, and imaging data. [Results] The PMKO group was significantly greater than the PKOA group in terms of ratio of trauma history [(yes/no), (36/2) vs (0/38), P＜0.001] and preoperative Q angle [(15.3±3.0)° vs (12.8±3.3)°, P＜0.001], and the severity preoperative lateral compartmental Kellgren-Lawrence (K-L) classification [0/1/2/3/4, (0/0/1/13/24) vs (0/0/3/21/14), P=0.020], while the former proved significantly less than the latter in term of preoperative knee flexion contracture angle [(5.6±3.9)° vs (8.2±4.5)°, P=0.014]. There was no statistically significant difference between the two groups in terms of surgical time, total incision length, intraoperative blood loss, postoperative drainage volume, incision healing, and hospital stay (P＞0.05). The male got significantly longer asymptomatic survival period than the female after meniscectomy in the PMKO group (P＜0.05). All patients in both groups were followed up for (63.2±24.6) months on an average, and no revision surgery happened in anyone of them. There were no statistically significant differences in VAS, OKS score, ROM, femorotibial angle (FTA), medial proximal tibial angle (MPTA), and posterior tibial slope angle (PTSA) between the two groups at the latest follow-up (P＞0.05). [Conclusion] The mid-term clinical consequence of lateral UKA for knee lateral compartmental osteoarthritis is satisfactory. The history of lateral meniscus resection has no significant impact on the postoperative outcome of lateral UKA.