微创单髁置换术治疗膝关节单间室骨性关节炎

目的探讨微创单髁置换术治疗膝关节单间室骨性关节炎的临床疗效。方法2011年10月～2013年3月，对51例（54膝）膝关节内侧间室骨性关节炎采用髓外定位法进行胫骨及股骨截骨，骨水泥固定OxfordⅢ单髁置换假体并植入移动半月板。观察切口长度，手术时间，手术前后血红蛋白下降量，术后直腿抬高时间，膝关节活动范围，术后髋膝踝角及并发症；采用Oxford评分法对术前、术后膝关节功能进行评估。结果2例出现内衬脱位并发症进行翻修。无感染、下肢深静脉血栓、假体位置不良，假体松动等并发症。切口长度（6．6±0．8）cm（5．5～8cm）。手术时间（59．9±6．6）min（50～80min），术后3d血红蛋白下降（13．5±5．0）g／L（7～28g／L）。术后自主直腿抬高时间（3．4±1．6）d（1～8d）。术后2～3d行双下肢全长片检查，髋膝踝178．2°±2．6°（177°～183°）。术后无伸直受限，最大屈曲度121．3°±6．6°（110°-130°）。51例术后随访6～23个月，平均14．5月，无感染、下肢深静脉血栓、假体位置不良，假体松动等并发症。Oxford膝关节功能评分术前（24．6±1．9）分，术后末次随访（41．6±3．5）分，术前后比较有统计学差异（t=34．313，P=0．000）。结论微创单髁置换术治疗内侧间室骨性关节炎短期效果良好，中远期疗效需要进一步随访。

Minimally Invasive Unicompartment Knee Arthroplasty for Unicompartment Knee Osteoarthritis

Objective To explore the clinical efficacy of minimally invasive unicompartment knee arthroplasty（MI-UKA） for unicompartment knee osteoarthritis. Methods From October 2011 to March 2013,51 patients （54 knees） with unicompartment knee osteoarthritis were treated with MI-UKA. Tibia and femur osteotomy were performed via extramedullary alignment guidance, and then meniscal-bearing unicompartment prosthesis （ Oxford Phase III ） was fixed with bone cement. Incision length, operative time, decreased hemoglobin values before and after surgery, time to straight leg raise, range of motion, postoperative hip-knee-ankle angle and complications were observed. The function results were assessed preoperatively and postoperatively by Oxford scores. Results Two patients underwent revision surgery due to bearing dislocation. The mean incision length was （ 6.6 ± 0.8 ） cm （ range, 5.5 - 8 cm） ; the mean operative time was （59.9 ± 6.6） min（ range, 50 -80 min） ; the mean decreased hemoglobin values was （13.5 ± 5.0） g/L（range, 7 -28 g/L） 72 h postoperatively; the mean time to straight leg raise was （3.4 ±1.6） d（range, 1 -8 d） after the surgery; and the mean postoperative hip-knee-ankle angle measured by lower limbs X-ray was 178.2° ± 2.6° （range, 177 ° - 183°）. The range of motion of knee reached a mean of 121.3° （range, 110° -130°）. There was a statistical difference in Oxford scores between before and after the surgery （24.6 ± 1.9） points vs. （41.6 ± 3.5 ） points, t = 34. 313, P = 0. 000 ]. Fifty-one cases were followed up for 6 to 23 months （ mean, 14. 5 months）, and no infection, deep venous thrombosis or prosthesis mal-position and loosening were observed. Conclusion Minimally invasive unicompartment knee arthroplasty is an effective alternative for the treatment of unicompartment knee osteoarthritis, however, mid- and long-term studies are still required.