LINK固定平台单髁置换术治疗膝单间室骨关节炎的临床研究

LINK固定平台单髁置换术治疗膝单间室骨关节炎的临床研究卢明峰;钟露斌;尹志豪;李泽晖;曹学伟
【期刊名称】《实用骨科杂志》
【年(卷),期】2017(23)11
【摘要】Objective To investigate the clinical efficacy of Link fixed-bearingunicompartmental knee arthroplasty (UKA) in the treatment of medial knee osteoarthritis (KOA).Methods We choose 55 patients who had Link fixedbearing unicompartmental knee arthroplasty from March 2014 to May 2016 in Guangdong Provincial Hospital of Traditional Chinese Medicine,including 25 males (25 knees) and 30 females (30 knees).The average age was 67 (53 ～ 81).The average weight was 64kg (45～83 kg).The patients were followed up for 12～26 months with an average of 15.6 months.All cases completed by the same surgeon,using a fixed platform Link unicompartmental prosthesis system line medial condyle replacement,and minimally invasiving UKA take small incision technique.The patients were collected for statistical analysis of the operation time,blood loss,postoperative hospital stay,hospitalization costs and other data.To observe the occurrence of postoperative complications after UKA surgery.Before and after surgery,the anterior lateral knee joint X-ray and full-length negative double-arm X-ray were performed.The preoperative and postoperative femorotibial angle (FTA),hip-knee-ankle angle (HKA) and range of motion (ROM) of the knee joint were
measured.And at the time of the last follow-up,the hospital's special surgery knee score (HSS score),the American Knee Association score were evaluation.Data were processed and statistically analyzed using SPSS 18.0 software (P＜0.05 was considered statistically significant).Results The average operation time of 55 patients (55 knees) vvas 89.36 min.The mean intraoperative blood loss was 50.71 mL.The average length of postoperative hospital stay was 7.5 days and the average cost of hospitalization was 37 768.5 yuan.All patients underwent surgical resection with grade A healing without infection.Perioperative complications such as pulmonary embolism,deep venous thrombosis of lower
extremities,iatrogenic neurovascular injury and periprosthetic fracture occurred.Average follow-up 15.6 months (12 ～ 26 months),patients with quality of life was significantly improved compared with preoperative,all cases were no sterile prostheses loosening,unexplained pain,polyethylene liner dislocation and other complications.The preoperative HKA was (173.6 ± 3.5) ° and postoperatively(177.5 ± 1.4) °.The average preoperative FTA was (180.5 ± 4.2) ° and the average postoperative period was (175.4 ± 5.8) °.The maximal knee joint activityincreased from preoperative (9 4.5 ± 8.1) ° to postoperative (113.7 ±7.8) °.The above data,preoperative and postoperative compared,the differences were statistically significant (P ＜0.05).KSS functional scores were (58.7± 7.8)° and (86.4± 6.8)°.The HSS scores of knee joint at preoperative and final follow-up were respectively(46.5 ± 5.8) ° and (85.7 ± 8.7)°.Compared the data from last follow-up with that before surgery,there were statistically difference in the
three groups(P ＜0.05).Conclusion Unicompartmental arthroplasty with link Sled fixed-bearing single condylar prosthesis and minimally invasive single condylar technique is a good option for patients with osteoarthritis of the medial compartment of the knee.The reseans includ small trauma,less
bone resection,shorter operation time,less blood loss,shorter postoperative hospitalization time,less complication,quicker postoperative
recovery,greater joint activity,better body feelings and so on.The short-term effect is satisfactory,the alignment of lower limbs is improved obviously,and its long term effect needs further observation.%目的探讨
Link固定平台膝单髁置换(unicompartmental knee orthroplasty,UKA)治疗膝内侧单间室骨关节炎(knee osteoarthritis,KOA)的临床疗效.方法选取从2014年3
月至2016年5月在广东省中医院关节科行膝关节Link固定平台单髁置换术的患
者55例.其中男25例25膝,女30例30膝;平均年龄67岁(53～81岁);平均体重64 kg(45～83 kg);术后随访12～26个月,平均15.6个月.全部病例均由同一主刀
医生完成,使用Link固定平台单髁假体系统,行膝关节内侧髁置换,采取微创UKA小切口技术.统计患者手术时间、术中出血量、术后住院时间、住院费用等资料进行
疗效分析;观察有无UKA术后并发症出现;手术前后均行患侧膝关节正侧位X线片
及双下肢全长负重位X线片,分别测量术前及术后胫股角(femorotibial angle,FTA)、髋-膝-踝角度(hip-knee-ankle angle,HKA)、膝关节最大活动度(range of motion,ROM)并评估术前及末次随访时膝关节的美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)、美国膝关节协会评分(American knee society knee score,KSS).采用SPSS18.0软件对数据进行处理和统计学分析.结果 5 5例(5 5膝)患者手术时间平均为89.36min,术中平均出血量为50.71 mL,术后住院天数平均为7.5d,住院平均费用37 768.5元.所有患者手术切口
均为甲级愈合,均无感染、肺栓塞、下肢深静脉血栓、医源性神经血管损伤、假体
周围骨折等围手术期并发症出现;平均随访15.6个月(12～26个月),患者生活质量
较术前得到明显提高,所有病例均没有无菌性假体松动、不明原因疼痛、聚乙烯衬
垫脱位等并发症.术前HKA为(173.6±3.5)°,术后为(177.5±1.4)°;术前FTA为(180.5±4.2)°,术后为(175.4±5.8)°;术后膝关节最大活动度从术前(94.5±8.1)°增长
至术后的(113.7±7.8)°,以上数据,术前与术后相比,差异均有统计学意义(P＜0.05).
术前和末次随访膝关节KSS临床评分分别为(60.8±9.7)分和(88.9±5.1)分;KSS功
能评分分别为(58.7±7.8)分和(86.4±6.8)分;术前和末次随访时膝关节HSS评分分
别为(46.5±5.8)分和(85.7±8.7)分,三组评分,术前和末次随访相比,差异均有统计学
意义(P＜0.05).结论研究结果表明,对于膝内侧单间室骨关节炎患者,利用Link Sled 固定平台单髁假体,采用微创单髁技术行手术治疗,具有术中创伤小、切除骨质少、
手术时间短、失血量少,术后住院时间短、并发症少、术后恢复快、关节活动度大、本体感觉好等优势.术后近期疗效满意,下肢力线改善明显,其远期效果有待进一步观察.
【总页数】6页(P975-979,990)
【作者】卢明峰;钟露斌;尹志豪;李泽晖;曹学伟
【作者单位】广州中医药大学,广东广州 510403;广州中医药大学,广东广州510403;广州中医药大学,广东广州 510403;广东省中医院,广东广州 510120;广东
省中医院,广东广州 510120
【正文语种】中文
【中图分类】R684.3
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