移动平台单髁置换术治疗膝关节内侧间室骨性关节炎

目的评估移动平台单髁置换术治疗膝关节内侧间室骨性关节炎的临床疗效。方法回顾性分析自2011-10—2013—01使用Oxford Phase Ⅲ移动平台单髁系统治疗膝关节内侧间室骨性关节炎47例（50膝）．观察术后下肢力线、膝关节活动度和并发症,采用Oxford及AKS评分对手术前后膝关节功能进行评估。结果47例均获得随访,平均随访13（6～21）个月。未发生假体周围感染、假体周围骨折、下肢深静脉血栓、医源性神经血管损伤。2例出现内衬脱位,行翻修术,无感染。术后测量下肢力线平均内翻1．2°。Oxford评分：术前平均（24．6±1．9）分,术后平均（41．3±3．5）分。AKS疼痛评分：术前平均（50．5±3．9）分,术后平均（86．9±4．9）分。AKS功能评分：术前平均（47．0±6．6）分,术后平均（86．4±9．4）分。术后Oxford、AKS评分较术前明显提高,差异均有统计学意义（P〈0．05）。术后无伸直受限,最大屈曲度平均（121．0±6．7）°。结论移动平台单髁置换术治疗膝关节内侧间室骨性关节炎短期效果良好,但中远期疗效需进一步随访。     

关节镜辅助单髁置换术治疗膝内侧间室骨性关节炎的临床疗效观察

目的总结关节镜辅助单髁置换术治疗膝内侧间室骨性关节炎的临床疗效。方法选择自2008-03—2011-01行手术治疗的18例单侧膝关节骨性关节炎。均以膝关节内侧间室病损为主。术前进行MR及X线片评估;术中采用关节镜进行检查和清理。并行膝关节内侧间室单髁置换术：术后进行膝关节功能及影像学评估。结果所有患者均获平均21（18～36）个月随访,影像学检查显示假体位置良好,无松动与假体周围骨溶解的迹象。末次随访时膝关节功能HSS评分由术前71．3分提高至87．2分,优15膝,良3膝;平均关节活动范围（ROM）127°（112～141°）。结论关节镜下准确评估、清理关节病损为人工膝关节单髁置换术提供临床依据,提高了疗效,是治疗膝关节单间室骨性关节炎的有效方法。     

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。     

Advances in unicompartmental knee arthroplasty with minimally invasive techniques

Abstract Unicompartmental arthroplasty has proved to be a reliable option for monocompartmental arthritis in well selected patients. Unicompartmental knee arthroplasty (UKA) is not a temporary procedure and its ten year survival is comparable to TKA and better than High Tibial Osteotomy. The success of the procedure depends on strict patient selection, meticulous surgical technique and proper implant selection. The renewed interest in UKA is due to improved results, more conservative nature of the procedure, faster rehabilitation, decreased cost and the minimally invasive techniques. The sedentary patient with unicompartmental arthritis is currently the primary indication for UKA. The role of unicompartmental arthroplasty in younger patients needs more investigation. Revision of UKA has not found to be as complicated as reported in the early series. Minimally invasive UKA has shown short term promising results but more long term studies showing similar implant longevity compared with the standard approach are required to establish its role. Due to high level of patient satisfaction and low morbidity and complications compared with TKA, unicompartmental arthroplasty is an attractive option for patients with predominantly unicompartmental non inflammatory arthritis.     

前交叉韧带重建联合单髁置换术的临床应用进展

膝关节单髁置换术在治疗骨关节炎方面取得了巨大的成功,但对前交叉韧带缺陷合并内侧间室骨关节炎患者的治疗目前仍存在争议,手术方式选择有限。前交叉韧带重建联合单髁置换术是一种有效的治疗方式,但目前临床上大多数关节外科医师对于该技术仍缺乏了解和认识,本文就该技术的进展作一综述。     

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。     

机器人膝关节单髁置换术护理配合

目的:总结机器人辅助膝关节单髁置换术(Unicompartmental knee arthroplasty,UKA)的护理配合要点.方法:回顾性分析2019年6月～2019年11月北京大学人民医院11例机器人UKA的护理配合情况,总结术中手术配合情况,并对手术效果进行观察总结.结果:11例患者手术均顺利完成,术后康复良好,未发现并发症.结论:术前充分的准备和术中熟练的手术配合是机器人辅助膝关节单髁置换术护理配合成功的关键.     

机器人辅助下单髁置换术的研究现状及进展

单髁置换术(UKA)对单间室骨关节炎患者来说是一种可选择的术式。与全膝关节置换术(TKA)比较,UKA的优势包括手术风险低、恢复快、患者满意度高、住院时间短等。然而,与TKA比较,UKA的翻修率更高,假体生存率更低。假如能提高传统UKA的假体生存率和降低其翻修率,UKA将会发挥独特的优势。目前,机器人辅助UKA正引起人...     

固定平台单髁置换术治疗膝关节前内侧骨关节炎的早期临床疗效

目的探讨微创小切口固定平台单髁置换术治疗膝关节前内侧骨关节炎的早期临床疗效。方法回顾性分析2018年5月至2019年10月在我科行小切口固定平台内侧单髁置换术的40例病人(43膝)的临床资料,其中男19例(20膝),女21例(23膝),年龄为(63.3±5.23)岁(53～79岁)。记录并分析病人手术时间、出血量、下地时间和并发症,术前和末次随访时病人的膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国膝关节协会评分(Knee Society Score,KSS)、牛津大学膝关节评分(Oxford Knee Score,OKS)、膝关节最大活动度(range of motion,ROM)、髋-膝-踝角(hip-knee-ankle angle,HKA)等。结果病人手术时间为(79.14±5.44)min,出血量为(85.12±10.32)m L,下地时间为(9.65±5.36)h。病人均获得随访,随访时间平均为10.2个月。术后VAS、KSS和OKS评分均较术前明显改善(P均<0.05);术后膝关节ROM较术前明显改善且差异有统计学意义(t=-...     

微创膝关节单髁置换术治疗70岁以上老年膝关节内侧间室骨性关节炎

目的探讨微创膝关节单髁置换术(MIS-UKA)治疗70岁以上老年膝关节内侧间室骨性关节炎的可行性及初步疗效。方法采用MIS-UKA治疗70岁以上老年膝关节内侧间室骨性关节炎21例(24膝)。评估切口大小、手术时间、出血量、引流量和并发症。比较术前、术后膝关节HSS评分、膝关节活动度及下肢力线(髋膝踝角)。结果术后平均随访18个月(12～24个月)。末次随访患者膝关节内侧间室疼痛明显减轻,HSS评分明显增加,下肢力线内翻畸形明显减少,但膝关节活动度无明显改善,无感染、脂肪栓塞或下肢深静脉血栓形成,假体位置不良、脱位,假体松动等并发症。结论 MIS-UKA可治疗70岁以上老年膝关节内侧间室骨性关节炎,但远期疗效尚需进一步随访。     

Computer-assisted unicompartmental knee arthroplasty using dedicated software versus a conventional technique

Purpose

The aim of this study was to retrospectively compare the results of two matched-paired groups of patients who had undergone a medial unicompartmental knee arthroplasty (UKA) performed using either a conventional or a non-image-guided navigation technique specifically designed for unicompartmental prosthesis implantation.

Methods

Thirty-one patients with isolated medial-compartment knee arthritis who underwent an isolated navigated UKA were included in the study (group A) and matched with patients who had undergone a conventional medial UKA (group B). The same inclusion criteria were used for both groups. At a minimum of six months, all patients were clinically assessed using the Knee Society Score (KSS) and the Western Ontario and McMaster Osteoarthritis Index (WOMAC) index. Radiographically, the frontal-femoral-component angle, the frontal-tibial-component angle, the hip-knee-ankle angle and the sagittal orientation of components (slopes) were evaluated. Complications related to the implantation technique, length of hospital stay and surgical time were compared.

Results

At the latest follow-up, no statistically significant differences were seen in the KSS, function scores and WOMAC index between groups. Patients in group B had a statistically significant shorter mean surgical time. Tibial coronal and sagittal alignments were statistically better in the navigated group, with five cases of outliers in the conventional alignment technique group. Postoperative mechanical axis was statistically better aligned in the navigated group, with two cases of overcorrection from varus to valgus in group B. No differences in length of hospital stay or complications related to implantation technique were seen between groups.

Conclusion

This study shows that a specifically designed UKA-dedicated navigation system results in better implant alignment in UKA surgery. Whether this improved alignment results in better clinical results in the long term has yet to be proven.     

Medial tibial plateau fracture complicating unicompartmental knee arthroplasty

We describe a new cause of a medial tibial plateau fracture complicating the early postoperative rehabilitation following unicompartmental knee arthroplasty. The patient was successfully treated by open reduction and internal fixation by buttress plating the fracture and retaining the prosthesis. The treatment option used proved to be successful, although careful patient selection for unicompartmental knee arthroplasty should be recommended to decrease the risk of this complication.     

Planning for minimally invasive unicompartmental knee arthroplasty

Unicompartmental knee arthroplasty (UKA) is considered the treatment of choice in patients with single compartment arthritis of the knee at early stages or with osteonecrosis limited to one compartment. However, results in the literature are still controversial and it is a technically difficult procedure. The main goal of UKA is to restore the articular space of the afflicted compartment, without influencing the limb alignment. Selection of patients and pre-operative planning are crucial. The necessity to improve functional results and to reduce immobilization of the patients has led to the development of minimally invasive surgery. Applied to UKA, this approach reduces blood loss and surgical time, causes fewer symptomatic postoperative complications, and permits earlier recovery compared to the traditional incision. The shorter incision makes careful pre-operative planning essential. We briefly review the indications for UKA, the pre-operative clinical and radiological assessment, and the surgical procedure. Proocedings of the Consensus Conference “TSS in hip and knee replacement” (Rapallo, Italy 22–24 June 2006)     

小切口单髁置换术治疗膝关节内侧间室骨关节炎94膝的中短期疗效研究

[目的]探讨小切口单髁置换术治疗膝关节内侧间室骨性关节炎的中短期疗效与手术技术。[方法]回顾性分析本院2003年1月～2010年6月收治的87例(94膝)经小切口单髁置换术治疗的膝关节内侧间室骨性关节炎患者的资料。对患者膝关节疼痛VAS评分、关节活动度、膝关节HSS评分、关节力线等进行评估分析,分析单髁关节置换临床效果、遇到的问题及应对方法。[结果]术后平均随访3.4年(6个月～7年),返修2例,无感染、深静脉血栓、假体脱位等,HSS评分由术前61.05分增至92.67分,优良率达92%。VAS评分由术前6.46分降至2.80分。术后疼痛缓解率94%。膝屈曲度平均达127.53°。术后力线平均内翻2°。[结论]小切口单髁置换术治疗膝关节内侧间室骨性关节炎中短期疗效满意,具有创伤小、恢复快、症状改善明显、术后功能良好等特点。     

(iii) Modern unicompartmental knee replacement

Unicompartmental knee replacement (UKR) or arthroplasty (UKA) has undergone a resurgence of interest and usage in recent years. This is partly due to the development of minimally invasive surgery (MIS) techniques for UKR. Many experienced arthroplasty surgeons correctly consider that UKR is more technically demanding than total knee replacement (TKR). However, in appropriately selected patients and with carefully performed surgery, the known benefits of UKR can be safely offered. Many previously learned lessons have had to be rediscovered to enable this technically demanding procedure. MIS has been demanded by patients and offered by surgeons but the limited surgical access makes the technical intricacy of UKR surgery even more demanding. Computer aided surgery (CAS) has emerged as a probable solution to this problem. This article examines the current place of UKR in arthroplasty surgery with particular reference to the new techniques of MIS and CAS. UKR has an important place in the selection of surgical options for the treatment of unicompartmental knee arthritis because of the rapid recovery, lower complication rate and high success rate compared to other available procedures.     

Oxford单髁置换治疗膝内侧间室骨性关节炎

目的探讨Oxford单髁置换(UKA)治疗膝内侧间室骨关节炎的临床疗效。方法采用Oxford UKA治疗25例膝内侧间室骨关节炎患者(26膝)。采用膝关节功能HSS评分评价疗效。结果 25例患者均获随访,时间8~16个月。术后患膝关节疼痛均明显缓解,关节活动度改善,生活质量提高。术后2周、3个月、6个月膝关节功能HSS评分、膝关节活动度均较术前增加,差异均有统计学意义(P0.01),术后2周、3个月、6个月膝关节屈曲挛缩度数均较术前减少,差异均有统计学意义(P0.01)。结论 Oxford UKA治疗膝内侧间室骨关节炎,具有术后功能恢复良好、并发症少等优点。     

A short-term radiological and clinical comparison between the bi-cruciate and cruciate retaining total knee arthroplasty A retrospective case controlled study

PurposeThe aim of this study was to provide a short term comparison in radiological and clinical outcome between Bi-Cruciate Retaining (BCR)- and Cruciate Retaining (CR) Total Knee Arthroplasty (TKA).MethodsThe cohort consists of 122 patients undergoing a TKA with PSI, equally distributed over the BCR- and CR-TKA group. Perioperative conditions were observed and radiological images were analysed pre-, 6-weeks, and 1-year postoperative to quantify alignment differences between BCR- and CR-TKA. Preoperatively predicted templates were compared with the implanted size to determine predictive value. In addition mean range of motion and revision rates were determined in both groups.ResultsNo significant difference was observed in amount of outliers in component alignment between BCR- and CR-TKA. Outliers of the Hip-Knee-Ankle-Axis (HKA-axis) occurred significantly more frequent (P = 0.009) in the BCR-group (37.7%) compared to CR-TKA (18.0%). No clinically relevant differences regarding the predictive sizing of implant components was obtained. No significant differences were observed in revision rates (P = 1.000) and ROM (p = 0.425) between the BCR-groep and CR-group at 2-years FU.ConclusionThis study illustrates that although the HKA-axis was not fully restored, bi-cruciate retaining surgical technique for BCR-TKA is safe and effective with comparable radiological and clinical outcome as CR TKA. Randomized controlled trials with longer follow up on the HKA-axis alignment and clinical parameters are needed to confirm the presented results and should focus on possible cut off values concerning leg axis in order to define in what patients a BCR-TKA can safely be used.Level of evidence IVRetrospective Case Controlled Study.     

小切口单髁置换术治疗膝关节内侧间室骨性关节炎的早期疗效观察

目的探讨小切口单髁置换术(UKA)治疗膝关节内侧间室骨性关节炎的临床效果。方法对15例(15膝)膝关节内侧间室骨性关节炎采用UKA治疗,术前行膝关节伸直位正侧位、双下肢全长正位、膝关节应力位、髌骨轴位X线片及膝关节MR检查,测量术前及术后膝关节主动活动度,并进行膝关节AKSS评分。结果所有患者随访4~16个月,平均10个月。末次随访时屈曲度与术前相比,差异有统计学意义(P<0.05);末次随访时AKSS评分与术前相比,差异有统计学意义(P<0.05)。结论小切口UKA治疗膝骨性关节炎早期疗效显著,具有创伤小、并发症少、术后功能恢复快的优点,中远期疗效有待于进一步随访。     

单髁置换术治疗膝单间室骨性关节炎的近期疗效

目的探讨单髁置换术治疗膝关节单间室骨性关节炎的近期疗效。方法回顾性分析26例经单髁置换术治疗的膝关节单间室骨性关节炎患者(28膝)的资料。采用HSS评分对患者术后膝关节疼痛与关节活动度进行评估,测量术后膝关节力线,分析手术的适应症证及术后疗效。结果患者均获得随访,时间3~32个月。28膝术后关节负重内侧间室疼痛明显减轻或消失,膝屈曲度为122°~135°(128.39°±4.69°),术后力线内翻角度为1.2°~4.0°(2.51°±0.10°)。术后HSS评分:优24膝,良2膝,可2膝。结论单髁置换术治疗膝关节骨性关节炎具有创伤小、恢复快、症状改善明显、延缓全膝置换时间等特点,近期疗效较好。     

胫骨高位截骨术与单髁置换术治疗膝内侧间室骨关节炎的疗效

目的 探讨胫骨高位截骨术(HTO)与单髁置换术(UKA)治疗膝内侧间室骨关节炎的疗效.方法 将60例膝内侧间室骨关节炎患者按治疗方法的不同分为HTO组和UKA组,每组30例.比较术中出血量、手术时间、术后引流量、并发症发生情况.记录两组术前及末次随访时疼痛VAS评分、Tegner膝关节运动评分、HSS评分.结果 患者均...