单髁置换术治疗中年膝关节内侧间室骨关节炎的中期疗效

摘要

目的 评价中年膝关节内侧间室骨关节炎患者单髁置换术的中期疗效.方法 2007年4月至2010年1月采用膝关节单髁置换术治疗中年膝关节内侧间室骨关节炎患者19例(21膝).男5例,女14例;年龄44～60,平均(51.0±5.1).采用美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分、美国西安大略和麦克马斯特大学(the Western Ontario and McMaster Universities,WOMAC)骨关节炎指数、疼痛视觉模拟评分(Visual Analogue Score,VAS)、关节最大屈曲度、Feller髌骨评分及SF-36进行功能及生存质量评估.手术前后及末次随访时摄患膝正侧位X线片,测量股胫角及外侧胫股关节间隙宽度,以翻修为终点事件评估假体生存率.结果 全部患者随访4～6.5年,平均(5.2±0.8)年.1年、3年随访时患者均恢复良好,假体生存率100％.末次随访时1例出现聚乙烯衬垫磨损,但无假体松动及活动时疼痛;1例出现聚乙烯衬垫严重磨损、假体松动,行翻修手术;其余患者均无继发性外侧间室和髌股关节退变加重症状,假体5年生存率91.7％(11/12).HSS膝关节评分由术前(60.4±5.2)分提高至末次随访时(88.1±6.8)分,WOMAC骨关节炎指数由术前42.9±5.9改善至末次随访时11.5±6.5,疼痛VAS评分由术前(6.6±0.7)分降至末次随访时(1.1±1.8)分,关节最大屈曲度由术前113.8°±11.5°提高至121.2°±11.1°,Feller髌骨评分由术前(19.3±7.0)分提高至末次随访时(25.2±6.6)分.股胫角术前179.5°±3.8°,术后175.3°±2.4°;外侧胫股关节间隙宽度术前(6.8±0.6) mm,末次随访时(6.7±0.6) mm.术后除躯体疼痛、生理功能及情感职能外患者其他各项生活质量指标均较人群标准下降,术后运动强度较术前下降.结论 中年膝关节内侧间室骨关节炎患者单髁置换术的中期疗效满意,假体5年生存率优良.%Objective To evaluate the mid-term clinical outcome of unicondylar knee arthroplasty (UKA) in patients in mid-ages.Methods Nineteen cases (21 knees) with the age less than sixty were treated with UKA from April 2007 to January 2010 and were followed up.The range of motion (ROM),the Hospital for Special Surgery (HSS) knee score,the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index,Feller score,femur-tibia angle (FTA),width of lateral tibiofemoral joint space,visual analogue scale/score (VAS) and SF-36 scale were documented.Results All patients were followed up for 4 to 6.5 years (mean,5.2 years).The 5-years survival rate was 91.7％.One revision was performed due to polyethylene spacer frayed and prosthesis aseptic loosening.The polyethylene spacer was frayed in another patient,but there were no symptoms.The HSS was 88.1±6.8 at the final follow-up,which was 60.4±5.2 preoperatively.The WOMAC was 11.5±6.5 at the final follow-up,which was 42.9±5.9 preoperatively.The VAS was 1.1± 1.8 at the final follow-up,which was 6.6±0.7 preoperatively.The ROM was 121.2°± 11.1° at the final follow-up,which was 113.8°± 11.5° preoperatively.The Feller score was 25.2±6.6 at the final follow-up,which was 19.3±7.0 preoperatively.The FTA was 175.3°±2.4° at the final follow-up,which was 179.5°±3.8° preoperatively.The width of lateral tibiofemoral joint space was 6.7±0.6 mm at the final follow-up,which was 6.8±0.6 mm preoperatively.No deterioration of the laterally compartment or patellofemoral joint cartilage destruction happened.All the parameters of life quality were below the standard values excluding the BP,RE and PF.The exercise intensity was also decreased postoperatively.Conclusion The efficacy of UKA in mid-ages was satisfied and the 5-years survival rate was high.