髌股关节退变对膝关节单髁置换术疗效影响的研究

摘要

目的 探讨膝前痛和影像学髌股关节退变对膝关节单髁置换术治疗内侧间室骨关节炎疗效的影响.方法 回顾性分析2006年1月至2010年12月采用膝关节单髁置换术治疗膝关节内侧间室骨性关节炎95例(100膝)患者的临床资料,其中男性34例,女性61例；年龄55 ～ 82岁,平均68.2岁.患者体重指数(BMI) 24～28 kg/m2,平均26.3 kg/m2.术前存在膝前痛的43膝(有膝前痛组),无膝前痛的57膝(无膝前痛组).采用Ahlback和Altman法对术前髌股关节影像学情况进行评估.采用牛津膝关节评分(OKS评分)、美国膝关节学会评分(AKS评分)和WOMAC骨关节炎指数评分(WOMAC评分)对术前、术后膝关节功能进行评估.术前与术后膝关节功能评分比较采用配对t检验,各组之间评分比较采用成组t检验.结果 所有患者均获得了完整的随访,随访时间24～84个月,平均50个月.无感染、脂肪栓塞或下肢深静脉血栓,无假体位置不良、脱位及假体松动等并发症.股骨假体内外翻角度平均-0.7°±5.2°,屈伸角度平均-0.8°±4.5°；胫骨假体内外翻角度平均-0.1 °±2.2°,屈伸角度平均-0.4°±2.4°.有无膝前痛的患者末次随访时的OKS评分(t=19.04和31.57)、AKS膝评分(t=38.56和40.34)、AKS膝功能评分(t=39.29和43.62)及WOMAC评分(t=43.22和47.06)均较术前显著改善(P＜0.01),且两组各评分之间比较差异无统计学意义(P＞0.05).根据Ahlback分级和Altman评分无论是否有髌股关节损害的患者末次随访时各项评分较术前均显著改善(P＜0.01),存在内侧髌股关节损害表现患者各项评分两组之间比较差异均无统计学意义(P＞0.05).根据Altman评分存在外侧髌股关节损害患者的OKS评分(t=2.56,P=0.01)、WOMAC评分(t=2.20,P=0.03)差于无外侧髌股关节损害患者；根据Ahlback分级存在外侧髌股关节损害患者的OKS评分(=2.29,P=0.02)差于无外侧髌股关节损害患者；AKS评分两组之间差异均无统计学意义(P＞0.05).结论 膝前痛和内侧髌股关节损害并不影响膝关节单髁置换术疗效,外侧髌股关节损害常提示疗效差于正常.%Objective To determine whether anterior knee pain and/or radiological evidences of degeneration of the patellofemoral joint influence the outcome of unicompartmental knee arthroplasty (UKA).Methods Between January 2006 and December 2010,95 consecutive patients (100 knees)with unicompartmental knee osteoarthritis were treated with Oxford UKA,including 34 males and 61 females.The mean age was 68.2 years (range,55-82 years).The average Body Mass Index was 26.3 kg/m2 (range,24-28 kg/m2).Pre-operative there were 43 knees (43.0％) with anterior knee pain and 57 knees (57.0％) without it.Pre-operative radiological status of the patellefemoral joint were defined using Ahlback and Altman systems.The pre-and post-operative results of Oxford Knee Score (OKS),American Knee Society Score (AKS) and Western Ontario and Macmaster (WOMAC) were compared using paired t-test,the results between different groups were compared using grouped t-test.Results All cases were followed up for average 50 months (24-84 months).At the last follow-up,none had complications of infection,fat embolism,deep vein thrombosis,malposition of prosthesis,dislocation or loosing.The mean femoral component alignment was-0.7° ± 5.2° (valgus/varus),-0.8° ± 4.5 ° (flexion/extension) ; the mean tibial component alignment was-0.1 ° ± 2.2° (valgus/varus),-0.4° ± 2.4° (flexion/extension).The clinical outcomes were significantly improved compared with pre-operation regardless of presence(OKS:t =19.04,P＜0.01 ;AKS knee:t =38.56,P ＜0.01 ;AKS function:t =39.29,P ＜0.01 ;WOMAC:t =43.22,P ＜0.01) or absence(OKS:t =31.57,P ＜0.01 ;AKS knee:t =40.34,P ＜0.01 ;AKS function:t =43.62,P ＜ 0.01 ; WOMAC:t =47.06,P ＜ 0.01) of anterior knee pain.The results were significantly improved compared with pre-operation(P ＜ 0.01)regardless of whether degeneration of the patellofemoral joint.There was no statistically significant difference in outcome between patients with evidence of degeneration in the medial patellofemoral joint and those without (P ＞ 0.05).Patients with lateral patellofemoral degeneration had a worse score than those without,OKS(t =2.56,P =0.01) and WOMAC (t =2.20,P =0.03) by the Altman score,OKS(t =2.29,P =0.02)by the Ahlback score.For AKS measures there was no statistically significant difference in outcome (P ＞ 0.05).Conclusions Neither anterior knee pain nor radiological evidence of medial patellofemoral joint degeneration would influnence the outcome of UKA,lateral patellofemoral joint degeneration have an increased risk of a poor result.