膝关节单髁置换中期随访报告

目的探讨膝关节单髁置换的技术特点和临床疗效。方法回顾性分析2005年1月至2009年5月,在本组行单髁置换的62例患者（85膝）,单侧39膝,双侧23例（46膝）;其中男8例10膝,女54例75膝。男：女为1：7．5;年龄44～78岁,平均63岁;内侧单髁置换79膝,外单髁置换6膝,所有患者均使用LINK单髁假体（WMdemar Link GmbH＆Co）,将术前及最后一次复查KSS评分分值及关节活动度对比,评定膝关节功能。术后定期拍x线平片评估假体位置及未置换间室退变情况。结果获得随访的患者62例85膝,平均随访时间65．8个月（48～99个月）。膝关节KSS评分：术前（58．22±20．07）分,术后最后一次随访（81．24±17．96）分（P〈0．01）。关节活动度：术前（126．73°±7．53°）,术后最后一次随访（124．65°±8．65°）（P〉0．05）。术后首次与最后一次随访X线平片检查,未置换间室退变进展不明显。5例患者6膝分别在术后11—42个月出现胫骨部分假体松动,3膝做全膝翻修术。另2例（3膝）患者服用镇痛药,可行走及坚持日常活动,目前在随访中。结论单髁置换可以获得良好的关节功能,在一定程度上减缓了膝关节退变进展速度,但胫骨假体松动有较高的发病率,需要高度重视。     

髌股关节退变对Oxford内侧单髁置换疗效的影响

目的本研究对因膝关节前内侧关节炎进行Oxford单髁置换的中国患者前瞻性收集数据和术中观察髌股关节情况,并探讨这一结论的正确性。方法研究包括本单位从2009年8月至2011年5月连续进行的50例（45例患者）单髁置换病例。术前记录膝关节疼痛的部位,放射学检查发现的髌股关节退变用Ahlback系统分级。对于术中观察到的股骨滑车软骨磨损情况用Weidow5级分级系统记录,其将软骨状况从无磨损到全层磨损分为0至Ⅳ级。在术后1年随访是用Hospitalfor Special Surgery膝关节评分系统和自我满意度评分对临床疗效进行评定。结果术前放射学检查发现17膝（34％）存在髌股关节退变。术中观察发现27膝（54％）存在股骨滑车软骨面磨损,其中19例（38％）位于滑车沟偏内侧,6例（12％）位于滑车沟中央,1例（2％）位于滑车沟偏外侧,共有3例（6％）全层软骨磨损,2例（4％）位于滑车沟偏内侧,1例（2％）位于滑车沟偏外侧。不论是放射学发现的髌股关节退变还是术中发现软骨磨损病例与髌股关节相对正常病例相比,临床疗效没有显著性差异。结论术前放射学发现的髌股关节退变和术中发现髌股关节软骨磨损均不能作为Oxford内侧单髁置换的反指征。因外侧髌股关节退变的相关数据较少,对这类患者选择单髁置换时应慎重。     

膝关节单髁置换术早中期并发症分析

1目的探讨膝关节单髁置换术（UKA）早中期并发症的原因及防治方法。方法回顾性分析2003～2013年本组行UKA共217膝的临床结果,对早中期并发症进行分析。男46膝,女171膝,平均年龄65．3岁。术前诊断为膝关节骨关节炎201膝,骨坏死16膝。结果术后平均随访5．8年,患者满意率87％,疼痛缓解率93％,膝活动度123°,HSS评分92分。所有病例无临床深静脉血栓和肺栓塞发生,无手术死亡病例。术后全膝关节置换翻修3例：1例假体松动、1例假体周围感染、1例对侧间室骨关节炎。Oxford半月板衬垫脱位2例,手术更换大号半月板衬垫。另有对侧间室骨关节炎1例未进行翻修。结论膝关节UKA治疗膝关节内侧间室病变中短期疗效满意,但存在特有并发症,应严格手术适应证、掌握手术操作原则及技术,完善围手术期处理,减少并发症的发生。     

单髁置换术治疗膝内侧间室骨关节炎近中期疗效

[目的]探讨单髁置换治疗膝内侧间室骨关节炎近中期临床疗效。[方法]回顾分析本科2015年2月~2018年12月60例(60膝)内侧间室膝骨关节炎行单髁置换术患者的临床资料。采用疼痛视觉模拟评分(VAS)、美国纽约特种外科医院膝关节评分(HSS)、美国膝关节协会评分(KSS)、膝关节活动度(ROM)对手术前后进行功能分析。[结果]术中平均出血量(109.00±15.32) ml,术后平均引流量(162.00±20.23) ml,术前及术后随访时,VAS、HSS、KSS评分比较差异有统计学意义(P0.05),ROM及膝关节功能明显改善。[结论]单髁置换术显著改善了患者膝关节功能,近中期疗效满意。     

单髁膝关节置换术后膝关节三维运动学特性研究

目的探讨单髁膝关节置换后膝关节与骨关节炎病变膝关节及正常膝关节在正常平地行走中的三维运动学差异。方法在瑞金医院骨科2011年3月至2012年5月间进行的7例单髁膝关节置换手术病例和10位健康人对照组进行步态分析比较。7例单髁病例中,男1例,女6例,平均年龄65．3岁（53～73岁）,步态分析时间距手术后平均7个月（4～12个月）,所有单髁膝关节置换均使用Oxford（BiometLtd）活动平台内侧单髁膝关节假体,手术病例对侧膝关节也存在内侧间隙骨关节炎并等待进行手术。10例健康人中,男5例,女5例,平均年龄56．8岁（53～6l岁）,所有健康人对照组均无髋膝关节疼痛和髋膝关节活动功能障碍病史。本研究采用红外运动捕捉系统（MX．F40,Vicon,OxfordUK）,对多点体表标记点进行步态数据记录,计算股骨相对于胫骨的旋转和移动运动学数据,比较单髁膝关节置换后膝关节在上述三维运动中与对侧病变膝关节和正常膝关节的差异。结果在步态周期内,单髁膝关节置换术后膝关节三维运动学表现与对侧病变膝关节及正常对照组膝关节均存在不同的差异。其中,在矢状面屈伸运动、水平面的内外旋运动、冠状面内外翻运动以及前后方向平移运动中,单髁置换后膝关节运动曲线都与正常膝关节更为接近。结论单髁膝关节置换术后,膝关节运动学表现上比对侧病变膝关节在旋转运动和平移运动中,更接近与正常膝关节的运动学特性。     

活动平台与固定平台内侧单髁膝关节置换术后疗效对比的Meta分析

目的对使用活动平台和固定平台膝关节内侧单髁假体置换术的疗效差异进行Meta分析。方法检索Ovid Medline和Pubmed（1966年至2013年3月）、Embase（1980年至2013年3月）、Cochrane Central Register of Controlled trials（2013年）和中国生物医学文摘数据库（1990年至2013年）,检索全部有关活动平台与固定平台膝关节内侧单髁假体置换术后的疗效对比的随机或非随机对照研究,采用Revman5．2统计软件进行Meta分析。结果纳入前瞻性随机对照研究3篇,回顾性对照研究4篇。因数据不足无法对术后临床结果,影像学及运动学评估进行Meta分析。两种假体术后聚乙烯衬垫磨损发生率（风险差0．11,95％可信区间[0．02,0．61],P〈0．05）和衬垫脱位发生率（风险差7．10,95％可信区间[1．51,33．43],P〈0．05）之间差异有统计学意义;手术翻修率（风险差1．05,95％可信区间[0．67,1．64],P〉0．05）及其它翻修原因两种假体之间差异无统计学意义。影像学评估发现活动平台假体术后下肢力线通过中央区的例数明显高于固定平台假体（P〈0．05）,非正常的力线分布两种假体之间也存在明显差异（p〈0．05）。结论本Meta分析发现活动平台与固定平台内侧单髁假体置换术后的临床结果和手术翻修率均无差异。两种假体术后聚乙烯衬垫磨损和衬垫脱位的发生率差异有统计学意义。活动平台假体在恢复下肢正常力线方面更有优势。     

全膝关节置换治疗僵硬膝关节的早期疗效分析

目的 评价人工全膝关节置换治疗僵硬膝关节的疗效,探讨术中操作和术后康复的要点.方法 2005年2月至2009年4月,采用人工全膝关节置换治疗僵硬膝关节患者23例34膝,男3例4膝,女20例30膝;年龄25～73岁,平均为56.9岁.临床评价指标包括美国特种外科医院评分(hospital for special surgery knee score,HSS)及关节活动范围,并统计术后并发症.结果 平均随访时间为32.2个月(24～40个月),无失访病例.HSS评分术前平均(42.9±5.2)分(24～66分),术后1个月时平均为(72.4±7.1)分(58～82分),末次随访时平均为(85.7±4.3)分(66～94分),较术前增加42.8分.膝关节屈伸活动范围术前平均为42.6°±5.7°(25°～50°),术后1个月时平均为80.2°±9.2°(60°～105°),末次随访时平均为89.2°±40.5°(60°～110°),较术前增加46.6°.12例16膝因术后活动范围不足90°,在术后3～8周进行静脉麻醉下的手法松解.末次随访时仍有6例8膝活动范围不足90°.结论 术中大范围的软组织松解、术后充分的肌力和活动范围训练是获得良好疗效的关键,对于术后关节活动范围不足的病例应及时采取静脉麻醉下的手法按摩松解.     

外侧与内侧单髁置换术治疗膝关节单间室骨关节炎中期临床疗效的对比研究

背景:单髁关节置换术(UKA)常用于治疗膝关节单间室骨关节炎(OA)。由于膝外侧间室与内侧间室在解剖学和运动学方面均存在差异,外侧UKA被认为是一种技术难度上更具挑战性的手术。目的:比较膝关节外侧单髁关节置换术(LUKA)与膝关节内侧单髁关节置换术(MUKA)治疗膝关节单间室OA的中期临床疗效。方法:回顾性分析2012年3月至2016年3月接受UKA的265例患者的临床资料,其中Oxford 3活动平台MUKA 189例,LINK-Sled固定平台LUKA 76例。记录两组患者的手术时间、术中出血量、术后引流量、术后并发症等。通过HSS评分、OKS评分、WOMAC指数、FJS评分、膝关节ROM评估临床疗效。通过术后X线片测量影像学评估指标:胫骨假体内外翻角(TCVA)、胫骨假体后倾角(TCPSA)、股骨假体内外翻角(FCVA)、股骨假体屈曲角(FCPSA)。结果:随访时间为4~6年,平均(5.1±0.8)年。与MUKA相比,LUKA的手术时间长、术后引流量少、术后第1日的患肢肿胀程度轻以及膝关节活动度大(P<0.05),两组的术后下地时间、住院天数、手术出血量、术后第3日的患肢肿胀程度比较,差异均无统计学意义(P>0.05)。两组术前与末次随访的HSS评分、OKS评分、WOMAC及FJS评分比较,差异均无统计学意义(P>0.05)。两组的TCVA、TCPSA、FCVA、FCPSA比较,差异有统计学意义(P<0.05)。术后均未见假体无菌性松动、下沉等。MUKA组术后发生衬垫滑脱2例,下肢肌间静脉血栓2例,皮肤浅层感染1例;LUKA组出现1例膝内侧进展性OA,翻修采用MUKA。结论:LUKA技术要求更高,在严格把握手术适应证的基础上,不断提高手术技术,精准把握假体定位和屈伸间隙平衡,避免畸形矫正过度,可以获得与MUKA同样优良的临床疗效。     

应用Oxford单髁置换术治疗年轻膝内侧单间室骨关节炎患者的早期疗效

目的探讨应用Oxford单髁置换术治疗55岁及以下膝内侧单间室骨关节炎患者的早期疗效。方法回顾性分析2014年1月至2016年12月在北京积水潭医院矫形骨科行Oxford活动平台单髁置换术治疗的47例(56膝)55岁及以下膝内侧单间室骨关节炎患者的病历资料。术前及末次随访记录患者的牛津大学膝关节评分(OKS)、视觉模拟评分(VAS)、膝关节活动度(ROM)及机械轴股骨胫骨角(mFTA),并分析患者术后并发症发生率及假体生存率。结果手术年龄为(52.77±2.28)岁。随访时间为(42.16±9.60)个月。ROM由术前的(114.02±5.75)°提高至术后的(120.35±8.63)°,差异有统计学意义(P<0.05)。VAS评分由术前的(6.14±0.86)分降低至术后的(1.18±1.38)分,差异有统计学意义(P<0.05)。mFTA角由术前的(7.14±2.66)°改善至术后的(4.10±2.39)°,差异有统计学意义(P<0.001),且无膝关节内翻过度矫正。OKS评分由术前的(20.04±3.88)分提高至术后的(42.07±4.58)分,差异有统计学意义(P<0.001),优良率为91.1%。5例患者术后残留持续疼痛。随访期间,未发生其他严重并发症,假体生存率为100%。结论Oxford单髁置换术可显著改善年轻膝内侧单间室骨关节炎患者的临床症状和膝关节功能,早期疗效满意。残留疼痛是Oxford单髁置换术后最常见的并发症。     

全膝关节置换治疗僵硬膝关节的早期疗效分析

Objective To evaluate the outcome of primary total knee arthroplasty (TKA) in treatment of stiff knee, and discuss the key points of operative technique and rehabilitation. Methods From February 2005 to April 2009, 23 patients with 34 stiff knees were treated with primary TKA. The study included 3 males (4 knees) and 20 females (30 knees), with the mean age of 56.9 years. Primary disease of the patients included rheumatoid arthritis (26 knees in 15 cases) and osteoarthritis (8 knees in 8 cases). Varus deformity was found in 10 knees (5°-15°), and valgus was found in 5 knees (5°-10°). Evaluations included preoperative and postoperative range of motion (ROM) measurement, hospital for special surgery knee score (HSS), blood loss, operative time and assessment of postoperative complications. Results All patients were followed up. The mean follow-up time was 32.2 (range, 24 to 40) months. At the final follow-up visit, the HSS score increased from 42.9±5.2 preoperatively to 85.7±4.3, the range of motion increased from 42.6°±5.7° preoperatively to 89.2°±10.5°. Sixteen knees in 12 cases underwent manipulation at 3 to 8 weeks postoperatively for unsatisfied ROM, but ROM was still less than 90° in 8 knees at the last follow-up. The average blood loss were (632.4±180.2) ml in first 24 hours (450-850 ml) and the operative time were (98.1±18.6) min (80-150 min). Deep venous thrombosis was found in 3 patients. All the symptoms relieved after anticoagulant therapy. Postoperative varus deformity was seen in one patient, but the function of knee was good. No revision was needed. Conclusion Primary total knee arthroplasty is reliable method in treatment of stiff knees. Sufficient soft tissue release during the operation, postoperative muscle strength exercise and essential manipulation are key points for satisfactory outcomes.     

牛津膝关节评分与膝关节单髁置换术术后满意度的相关性研究

目的:比较手术前后牛津膝关节评分与膝关节单髁置换术后患者满意度的相关性以及确定不同满意度对应的牛津膝关节评分阈值。方法:选取2017年1月至2018年6月行膝关节单髁置换术患者88例,其中男24例,女64例;年龄52～77(65.39±7.33)岁。所有患者在术前和术后6个月完成牛津膝关节评分问卷以及满意度调查问卷。采用Spearman秩相关检验分析比较牛津膝关节评分和满意度之间的相关性,以满意度为金标准,绘制ROC曲线判断手术前后牛津膝关节评分对患者满意度的评判价值,并计算约登指数探索其最佳阈值。结果:术前牛津膝关节评分和满意度之间无明显相关性(r=-0.058,P0.05);术后牛津膝关节评分和满意度之间呈中度正相关(r=0.51,P0.05),即术后牛津膝关节评分越高,患者满意度越高。术前牛津膝关节评分的ROC曲线下面积为0.55[95%CI(0.40,0.70),P0.05],无统计学意义;术后牛津膝关节评分的ROC曲线下面积为0.95[95%CI (0.90,0.99),P0.05],有统计学意义。术后牛津膝关节评分阈值为35.5时,评判满意度的敏感度为0.86,特异度为1.00,约登指数最大,为0.86。以35.5分为阈值比较高分组与低分组患者满意率,差异有统计学意义(P0.001)。结论:术前牛津膝关节评分与膝关节单髁置换术后患者满意度相关性差,其在预测患者满意度方面不具有准确性,术后牛津膝关节评分与患者满意度具有明显相关性,术后牛津膝关节评分在35.5分及以上的患者可认为对手术效果满意。同时,结果证实牛津膝关节评分在对全膝关节置换术和膝关节单髁置换术后患者主观满意度的评价具有相同的阈值。     

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。     

Long-term clinical results of the Oxford medial unicompartmental knee arthroplasty

The purposes of this study were to investigate the mode of failure and survivorship of an independently performed series of medial Oxford unicompartmental knee arthroplasties. The study included 43 knees in 40 patients with a mean follow-up of 14.88 years: 13 knees (11 patients) had revision surgery (30%), and ten patients required conversion to total knee prosthesis. The mean International Knee Society (IKS) scores at the time of the revision were 145.52 [standard deviation (SD): 39.90, range: 167–200]. The overall alignment of the knee was restored to neutral, with a hip-knee-ankle (HKA) angle average of 178° (SD: 3.21°, range: 170–186°). Survivorship, as defined by an endpoint of failure for any reason, showed that the survival rate at five years was 90%, at ten years 74.7% and at 15 years 70%. Excluding inappropriate patient selection and surgeon-associated failures, our survival analysis plot is much improved: survivorship at five years is 94.5%, at ten years 85.7% and at 15 years 80.4%. The Oxford meniscal bearing arthroplasty offers long-term pain relief with good knee function. Unfortunately, we demonstrated a high complication rate, with some of the failures encountered indicating that the surgical technique is very demanding.     

Minimally invasive unicompartmental knee arthroplasty

The exact indication for a unicompartmental knee arthroplasty (UKA) remains debated. Minimally invasive techniques have been developed to decrease the surgical trauma related to the prosthesis implantation, and this technique is well fitted to UKA. However, there are concerns about loss of accuracy with minimally invasive techniques. Furthermore, rapid recovery techniques have been developed in order to reduce the length of hospital stay. Again, UKA is well fitted to these new developments of postoperative care. We combine routinely a minimal invasive operative technique with navigation assistance to ensure proper positioning of the implants as well as an optimal ligamentous balance. Instruments have been adapted for use with a typical 6-cm skin incision with little change from the conventional navigated operating technique. A multimodal pain treatment is implemented immediately after the implantation, with special attention to a routine saphenous nerve blockade. Patients are instructed to stand up on the day of surgery with full weight bearing and to mobilize the knee joint without restriction. They may be discharged at least on the day following surgery, and the most favorable patients may be operated in our day-case surgery unit. These conclusions should be confirmed on a larger scale.     

Revision of 33 unicompartmental knee prostheses using total knee arthroplasty: strategy and results

The purpose of this study was twofold: to evaluate the radiological and clinical results of 33 total knee arthroplasties (TKA) implanted between January 1993 and March 2005, to replace failed medial unicompartmental knee arthroplasty (UKA), and to develop a strategy to deal with bone defects in the tibial plateau. Failure was due to: tibial loosening (15 cases), femoral loosening (five cases), femoral and tibial loosening (two cases), polyethylene wear (five cases), lateral compartment osteoarthritis (two cases), patellofemoral osteoarthritis (two cases), laxity and PE dislocation (one case), and sepsis in one case. In 12 cases the tibial bone defect was filled with a metallic wedge, in seven we used an allograft (femoral head), and in one we used both. We report the results of 27 cases (five patients died and one was lost to follow-up). The mean follow-up was 73+/-41.7 months (range, 8-153) and the global IKS score was 166.72+/-21.3 points (range, 128-200). X-rays of the eight allografts showed osteointegration in all cases and no radiolucency was noted.     

The effect of implant constraint on results of conversion of unicompartmental knee arthroplasty to total knee arthroplasty

A series of unicompartmental knee arthroplasty (UKA) revision to total knee arthroplasty (TKA) was compared to a group of primary TKAs performed at the same institution. The UKA revision group had a higher incidence of local wound complications and inferior clinical results as measured by Knee Society scores. When the revisions were stratified by the degree of interface constraint, knees revised with posterior cruciate ligament (PCL) substituting designs had superior knee scores that were comparable to the primary group. The use of a PCL-substituting knee design is recommended when converting a UKA to TKA.     

膝关节单间室置换术的研究进展

膝关节单间室置换术（单髁置换术,unicompartmental knee arthroplasty,UKA）已沿用30多年,被认为是治疗膝关节单间室骨性关节炎及骨坏死的一种有效术式。此术式有很多成功病例的报道,也有引发灾难性后果需要再次手术的情况。由于UKA多采用微创手术方式,因而在术后恢复及患者病死率等方面优于全膝关节置换;并且有学者经过10年的随访,发现关节存活率令人满意。随着手术技术日趋成熟、关节假体制造工艺越来越精细、