膝关节单髁置换术研究进展

目的总结膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)的临床应用及研究进展。方法广泛查阅近年国内外UKA相关文献,从UKA新出现的手术指征、假体类型选择、与其他术式对比以及最新进展等方面进行总结分析。结果临床研究表明UKA具有创伤小、恢复快、术后并发症少等诸多优点。目前该手术适应证有所扩展,体质量指数>25 kg/m^2、年龄<60岁、髌股关节炎及前交叉韧带功能不良不再属于手术禁忌证。UKA术中假体类型的选择需要充分考虑患者情况。近年,临床逐渐开展的机器人辅助UKA可有效改善手术疗效,提高患者术后满意度,降低术后并发症。结论随着手术技术、假体材料及机器人技术的发展,UKA临床应用会更广泛,但目前大多为短、中期随访研究,需要进一步观察长期随访结果以指导临床实践。     

膝关节单髁置换术失败原因及翻修研究进展

目的 总结膝关节单髁置换术（unicompartmental knee arthroplasty,UKA）的失败原因及翻修手术研究进展。方法 查阅近年来国内外有关UKA翻修的文献,从失败原因、解决方法（包括评估骨缺损、翻修假体选择、手术操作等）方面进行总结。结果 导致UKA失败的原因包括适应证选择不当、手术技术不足与其他因素等。应用数字骨科技术可以减少因手术技术因素导致的失败,缩短学习曲线。UKA失败后的翻修手术有多种选择,包括聚乙烯衬垫更换、采用UKA或人工全膝关节置换术翻修,具体方案实施前需进行充分的术前评估。翻修手术面临的最大难题是骨缺损的处理与重建。结论 UKA存在一定失败风险,对其仍需谨慎对待,且应根据失败类型决定翻修方案。     

膝关节单髁置换术的研究进展

膝关节骨关节炎（Knee Osteoarthritis,KOA）是一种以膝关节软骨退行性病理改变为基础的的慢性疾病,多患于老年人。随着我国老龄化逐渐发展,该病已然成为老年患者的普发疾病。其中对于膝关节的单间室骨性关节炎,一般采用手术进行治疗,常用手术方式有胫骨高位截骨、全膝关节置换手术、单髁置换术。近二十年来,单髁置换术（UKA）的适应症有所扩大,具有手术更快、出血更少、成本更低和康复更快等优点。但目前主要还有一些问题仍存在争议,比如：UKA适应证、禁忌症如何;UKA与全膝置换术（TKA）、胫骨高位截骨（HTO）的疗效对比如何;UKA中的3D打印截骨手术方法效果如何。本文将对以上几个问题做一综述,进一步提高对UKA的认识。     

膝关节单髁置换术的发展研究进展

<正>1单髁置换术发展史随着人们对膝关节骨关节炎认识的加深,对于全关节严重破坏的患者,认为应用全膝关节表面置换(total knee arthroplasty,TKA)的手术方法可有效治疗骨关节炎。但临床工作中发现,许多骨关节炎患者仅一侧间室出现了明显的破坏,研究者开始考虑一种治疗单侧胫股关节间室病变的术式—膝关节单髁置换术     

膝关节单髁置换术

膝关节单髁置换术（unicompartmenlal knee arthroplasty,UKA）是指仅对膝关节内侧或外侧室进行表面置换,其主要用于治疗局限于单一间室的骨关节炎或骨坏死。由于单髁置换术保留了交叉韧带、髌股关节及对侧胫股间室,理论上能保留更正常的关节动力学,获得更大的活动度,保留骨量便于翻修为全膝关节表面置换。     

单室膝骨关节炎单髁与全膝置换术短期效果比较

[目的]比较单髁关节置换术(unicompartmental knee arthroplasty,UKA)与全膝关节置换术(total knee arthroplasty,TKA)治疗内侧单间室膝骨关节炎的临床效果.[方法]回顾性分析2017年5月—2019年5月本院手术治疗内侧单间室膝骨关节炎120例患者,依据术前医...     

比较全膝关节置换术与单髁置换术治疗老年单侧间室膝关节骨关节炎的效果

目的比较全膝关节置换术与单髁置换术治疗老年单侧间室膝关节骨关节炎的效果。方法将44例老年单侧间室膝关节骨关节炎患者根据治疗方法不同分为全膝关节置换组和单髁置换组,各22例。回顾性分析患者的临床资料。结果单髁置换组的手术时间、术中出血量和住院时间均显著低于全膝关节置换组,差异具有统计学意义(P<0.05)。术后3个月2组骨关节炎指数(WOMAC指数)和数字分级法(NRS)评分均显著降低(P<0.05),其中单髁置换组患者的WOMAC指数和NRS评分显著低于全膝关节置换组,差异有统计学意义(P<0.05)。结论单髁置换术治疗老年单侧间室膝关节骨关节炎,能缩短手术时间和住院时间,减少术中出血,有利于改善患者的膝关节功能和降低疼痛感。     

单髁关节置换术失败原因分析

人工膝关节单髁关节置换术(unieompartmental knee replacement-UKA)出现在20 世纪70年代,通过对病变间室置换,达到缓解疼痛、改善功能的目的,具有手术创伤小、骨量丢失少、术后康复快、接近生理状态等优点,是治疗膝关节单间室病变的有效方法[1].     

Unicompartmental knee arthroplasty

Recent increased interest in less invasive surgical techniques has led to a concurrent resurgence in unicompartmental knee arthroplasty. The procedure has evolved significantly over the past three decades. Proponents of unicompartmental knee arthroplasty cite as advantages lower perioperative morbidity and earlier recovery. Both clinical outcome and kinematic studies have indicated that successful unicompartmental knee arthroplasty functions closer to a normal knee. Recent reports have demonstrated success in expanding the classic indications of unicompartmental knee arthroplasty to younger and heavier patients. Both fixed- and mobile-bearing implants can yield excellent clinical outcomes at >10 years, but with different modes of long-term failure. Proper execution of surgical technique remains critical to optimizing outcome. Long-term studies are needed to appropriately define the role of less invasive unicompartmental surgical approaches as well as the role of computer navigation.     

Unicompartmental knee arthroplasty

Unicondylar knee arthroplasty is an alternative to tibial osteotomy for the treatment of medial or lateral compartment noninflammatory arthritis. It must be considered in the context of the other viable surgical options for treatment of this disorder. Appropriate patient selection and careful surgical technique will provide good to excellent results in over approximately 90% of individuals while preserving bone stock and ligamentous structures for revision if necessary.     

Unicompartmental total knee arthroplasty

This article traces the evolution of unicondylar design and examines its indications, common aspects of surgical technique independent of design, results, and complications. The dichotomy of opinion concerning unicompartmental knee arthroplasty may reflect differences in patient selection, prosthesis selection, and surgical technique.     

Unicompartmental knee arthroplasty following patellectomy

Patients with total knee arthroplasty following patellectomy have been reported to experience pain and instability. The results of ten patients with 11 knee arthroplasties using the Marmor knee were excellent in seven patients and good in three with an average follow-up period of nine years. It is extremely important to preserve the cruciate ligaments or to use a total knee prosthesis that has inherent anteroposterior stability.     

Unicompartmental Oxford Meniscal knee arthroplasty

Unicompartmental knee arthroplasty is an attractive concept, but some reports on its use are unfavorable. A meniscal bearing prosthesis has many advantages in this mode of arthroplasty. The authors present preliminary results of 25 unicompartmental knee replacements done with the Oxford Meniscal knee, with a follow-up period of 12-54 months (mean, 21 months). They discuss the scientific basis of unicompartmental knee arthroplasty, which they conclude may be the most appropriate treatment for selected cases of degenerative arthritis of the knee.     

Unicompartmental and total knee arthroplasty

Pain is the main indication for a total knee arthroplasty, and the choice of prosthesis should depend on the arthritic involvement of the joint. There is no substitute for early motion after the operation to regain knee motion. Unicompartmental replacement is valuable to preserve ligament and bony stock in properly selected cases. Excellent results can be expected in even elderly patients with severe arthritis if the operation is well performed.     

单髁膝关节置换治疗膝关节单间室病变

[目的]了解单髁膝关节置换治疗单问室膝关节病变的早期疗效,探讨单髁膝关节置换手术的手术适应证和手术技术难点.[方法]采用轻度矫正不足(slightly undercorrect)原则和内侧有限松解技术对15例各类单间室膝关节病变患者行单髁膝关节置换术,对术前和随访时HSS评分,股胫角,最大关节活动度进行统计分析,并测量胫骨假体后倾角度.[结果]HSS评分,股胫角,最大关节活动度均较术前有显著改善,胫骨平台后倾角度平均4.2°.[结论]单髁膝关节置换治疗膝关节病变的早期疗效可靠,严格把握手术适应证是单髁膝关节置换疗效的保证,内侧有限松解技术能有效改善屈曲挛缩.     

Unicompartmental porous coated anatomic total knee arthroplasty

Unicompartmental arthroplasty has been advocated for management of the older patient with unicompartmental arthritis. Implant breakage and loosening has led to modifications of implant design to metal backing and porous coating for potential bone ingrowth. A review of 28 cementless porous coated anatomic total knee arthroplasties two years after the operation revealed good to excellent results in 20 knees (71%). Six knees in five patients required revision for persistent pain. Only fibrous tissue ingrowth was observed. Five knees were considered potential failures based upon persistent pain and roentgenographic evidence of component loosening. This implant design is not acceptable with cementless fixation.