Oxford Ⅲ单髁系统治疗膝关节内侧间室退变的中期疗效

目的评价OxfordⅢ单髁系统治疗膝关节内侧间室退变的中期临床疗效。方法 2008年12月-2010年8月,收治26例(32膝)膝关节内侧间室退变患者,其中11例(14膝)获2年以上随访。男7例(9膝),女4例(5膝);年龄50～74岁,平均62.4岁。左侧6膝,右侧8膝。均为退行性关节炎,病程5～23年,平均11.6年。患者均有明确关节内侧间室负重疼痛和压痛。内侧间室骨性关节炎根据Ahlback分期标准,Ⅱ期4膝,Ⅲ期10膝。膝关节均伴内翻畸形;无主、被动屈伸活动受限。手术取髌内侧旁切口,采用OxfordⅢ单髁系统行膝关节内侧间室单髁置换手术。结果术后切口均Ⅰ期愈合。术后1～3个月5例出现切口下方局部鹅足疼痛症状,给予保守治疗,术后6个月复查症状均消失。术后11例(14膝)均获随访,随访时间24～30个月,平均27.5个月。随访期间无假体松动、移位,对侧间室和髌股关节病变、感染等并发症发生。末次随访时膝关节学会评分系统(KSS)评分、美国西部Ontario与McMaster大学骨关节炎指数评分(WOMAC)评分、膝关节活动度与术前比较,差异均有统计学意义(P<0.05)。末次随访时股胫角较术前改善(P<0.05),但仍为轻度内翻;胫骨平台内翻角较术前有所增大,但无统计学意义(P>0.05);胫骨内髁后倾角明显较术前减小,差异有统计学意义(P<0.05)。结论 OxfordⅢ单髁系统治疗膝关节内侧间室退变中期疗效满意,创伤小、恢复快;远期疗效尚需进一步观察。

Mid-term effectiveness of Oxford Unicompartmental Knee System Phase III for medial unicompartmental knee osteoarthritis

Objective To evaluate the mid-term effectiveness of Oxford Unicompartmental Knee system Phase III for medial unicompartmental knee osteoarthritis(OA).Methods Between December 2008 and August 2010,26 patients(32 knees) with medial unicompartmental knee OA were treated.Of 26 patients,11 were followed up more than 2 years,including 7 males and 4 females(14 knees,6 left and 8 right knees) with an average age of 62.4 years(range,50-74 years).All patients had load suffering and tenderness of medial unicompartmental knee,and complicated by varus deformity without limitation of flexion and extension;the disease duration ranged 5-23 years(mean,11.6 years).According to Ahlback staging,4 knees were at stage II and 10 knees at stage III.Cemented unicompartmental knee arthroplasty(Oxford Unicompartmental Knee system Phase III) was performed by minimally invasive technique.Results All the incisions were primary healing after operation.Five cases suffered from local ache in the pes anserinus during the first 3 months after operation,which was cured after conservative therapy.Of them,11 patients were followed up 27.5 months on average(range,24-30 months).During follow-up,no complication of prosthesis loosening,displacement,arthropathy in the opposite department,or the patellofemoral joint occurred.The range of motion was significantly improved from(109.2 ± 8.7)° preoperatively to(123.5 ± 6.7)° at last follow-up(P < 0.05);knee society score(KSS) and Western Ontario and McMaster University Osteoarthritis Index(WOMAC) scores were all significantly improved(P < 0.05).At last follow-up,the femoro-tibial angle was significantly improved(P < 0.05);tibial plateau and the tibial anatomical axis increased,showing no significant difference(P > 0.05);and posterior tibial slope was significantly decreased(P < 0.05).Conclusion Oxford Unicompartmental Knee system Phase III has satisfactory mid-term effectiveness in treating medial unicompartmental knee OA with the advantages of little trauma and rapid recovery,but long-term effectiveness is expected for further follow-up.