[1]卢明峰 杨伟铭 朱东平 曹学伟△.微创单髁置换术治疗膝关节自发性骨坏死的中短期疗效分析[J].中国中医骨伤科杂志,2017,25(10):32-37.
　LU Mingfeng YANG Weiming ZHU Dongping CAO Xuewei.Short-term Curative Effect Analysis of Minimally Invasive Monocular Replacement for Spontaneous Osteonecrosis of Knee Joint[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2017,25(10):32-37.
点击复制

微创单髁置换术治疗膝关节自发性骨坏死的中短期疗效分析()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第25卷
期数:
2017年10期
页码:
32-37
栏目:
临床论著
出版日期:
2017-10-15

文章信息/Info

Title:
Short-term Curative Effect Analysis of Minimally Invasive Monocular Replacement for Spontaneous Osteonecrosis of Knee Joint
文章编号:
1005-0205(2017)10-0032-06
作者:
卢明峰1 杨伟铭2 朱东平1 曹学伟2△
1广州中医药大学第二临床医学院(广州,510403) 2 广东省广州市广东省中医院 △通信作者 E-mail:1543896277@qq.com
Author(s):
LU Mingfeng1 YANG Weiming2 ZHU Dongping1 CAO Xuewei2△
1Guangzhou University of Chinese Medicine, Guangzhou 510403,China; 2Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120,China.
关键词:
单髁置换;  微创;  中短期;  自发性骨坏死
Keywords:
Keywords: unicompartmental knee arthroplasty;  minimally invasive;  short-term;  spontaneous osteonecrosis
分类号:
R687.3
文献标志码:
A
摘要:
目的:探讨微创单髁置换术治疗膝关节自发性骨坏死的中短期临床效果及手术技术,以期为临床工作提供依据。方法:选取本院2014年1月至2016年12月因膝关节自发性坏死行膝关节微创单髁置换术(UKA)治疗的68例患者作为研究对象,所有患者都经MRI明确诊断,同时排除外侧间室和髌骨关节严重退变的患者。全部病例均由同一主刀医师完成,使用第三代牛津膝单髁假体系统,行膝关节内侧单髁置换,采取微创UKA小切口技术。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,对膝关节HSS评分、膝关节疼痛VAS评分、关节活动度、下肢力线等进行评估分析,同时观察有无UKA术后并发症出现,分析单髁关节置换临床效果。结果:本研究68例患者均获得随访,其中男28例28膝,女36例36膝,平均随访时间为(15.3±8.1)个月。平均年龄(66.53±7.51)岁,平均体质量(66.45±12.00)kg,平均BMI指数为22.36±3.12,平均手术时间为(68.36±12.27)min,平均出血量为(75.00±25.35)mL,平均住院时间为(7.80±2.26)d.骨坏死患者术前术后VAS及HSS评分比较,差异有统计学意义(P<0.05),两组患者术前和随访时FTA,HKA,ROM比较,差异有统计学意义(P<0.05)。所有病例均无死亡、肺栓塞、下肢静脉血栓形成、心脑血管意外、创伤后精神障碍等严重并发症发生。结论:微创单髁置换术治疗膝关节自发性骨坏死中短期疗效满意,具有创伤小、恢复快、症状改善明显、术后功能良好等特点。
Abstract:
Abstract Objective: To investigate the short -term clinical effect and surgical technique of minimally invasive monocular replacement for the treatment of spontaneous osteonecrosis of knee joint, so as to provide the basis for clinical work. Methods: From January 2014 to December 2016, 68 patients with spontaneous necrosis of the knee were treated with minimally invasive single-condylar arthroplasty in our hospital. All patients were diagnosed by MRI and patients with lateral degeneration from the lateral compartment and patella joints were excluded. All cases were performed by the same surgeon, using the third generation of Oxford knee condylar prosthesis system, the knee lateral medial condylar replacement, to take minimally invasive UKA small incision technique. The X-ray film of the ipsilateral knee and the total length of the lower extremities were analyzed before and after the operation. The HSS score, knee joint pain VAS score, joint mobility and lower limb force line were analyzed. The complications of UKA were observed and the clinical effect of single condylar joint replacement was analyzed. Results: In this study, 68 patients were followed up, including 28 males 28 knees and 36 females 36 cases. The mean follow-up time, mean age, mean weight, mean BMI, mean operative time, mean blood loss, average hospital stay were(15.3±8.1)months,(66.53±7.51)years,(66.45±12.00)kg,(22.36±3.12),(68.36±12.27)min,(75.00±25.35)mL,(7.80±2.26)d, respectively.The difference of VAS and HSS scores before and after operation was statistically significant(P<0.05).The difference of FTA, HKA and ROM between preoperation and follow-up was statistically significant(P<0.05).No severe complications such as death, pulmonary embolism, lower extremity venous thrombosis, cardiovascular and cerebrovascular accident, post-traumatic mental disorders and other serious complications were found in all cases. Conclusion: Minimally invasive monocular replacement of knee joint spontaneous osteonecrosis is satisfactory in the short term efficacy, with small trauma, quick recovery, obvious improvement of symptoms, good postoperative function and soon.

参考文献/References:

[1] Ahlback S,Bauer GC,Bohne WH.Spontaneous osteonecrosis of the knee[J].Arthritis Rheum,1968,11(6):705-733.
[2] 康鹏德,裴福兴.膝关节骨坏死[J].中华骨科杂志,2010,30(12):1235-1240.
[3] Bruni D,Iacono F,Raspugli G,et al.Is unicompartmental arthroplasty an acceptable option for spontaneous osteonecrosis of the knee[J].Clin Orthop Relat Res,2012,470(470):1442-1451.
[4] Heyse TJ,Khefacha A,Fuchs-Winkelmann S,et al.UKA after spontaneous osteonecrosis of the knee:a retrospective analysis[J].Arch Orthop Trauma Surg,2011,131(5):613-617.
[5] Pandit H,Jenkins C,Barker K,et al.The Oxford medial unicompartmental knee replacement using a minimally invasive approach[J].J Bone Joint Surg Br,2006,88(1):54-60.
[6] Goodfellow J,O'Connor J,Dodd C.Unicompartmental arthroplasty with the oxford knee[J].New York:Oxford University Press,2006.
[7] Mcgrory B,Weber K,Lynott JA,et al.The american academy of orthopaedic surgeons evidence-based clinical practice guideline on surgical management of osteoarthritis of the knee[J].J Bone Joint Surg Am,2016,98(8):688-692.
[8] 李子荣.骨坏死[M].北京:人民卫生出版社,2012:260-268.
[9] Koshino T.The treatment of spontaneous osteonecrosis of the knee by high tibial osteotomy with and without bone-grafting or drilling of the lesion[J].J Bone Joint Surg Am,1982,64(1):47-58.
[10] Patel DV,Breazeale NM,Behr CT,et al.Osteonecrosis of the knee:current clinical concepts[J].Knee Surg Sports Traumatol Arthrosc,1998,6(1):2-11.
[11] Yamamoto T,Bullough PG.Spontaneous osteonecrosis of the knee:the result of subchondral insuyciency fracture[J].J Bone Jt Surg Am,2000,82(6):858-866.
[12] Bonutti PM,Seyler TM,Delanois RE,et al.Osteonecrosis of the knee after laser or radiofrequency-assisted arthroscopy:treatment with minimally invasive knee arthroplasty[J].J Bone Jt Surg Am,2006,88(3):69-75.
[13] Faletti C,Robba T,de Petro P.Postmeniscectomy osteonecrosis[J].Arthroscopy,2001,18(1):91-94.
[14] Prues-Latour V,Bonvin JC,Fritschy D.Nine cases of osteonecrosis in elderly patients following arthroscopic meniscectomy[J].Knee Surg Sports Traumatol Arthrosc,1998,6(3):142-147.
[15] 薛华明,蔡珉巍,涂意辉.膝关节外侧间室单髁置换术临床应用进展[J].中华关节外科杂志:电子版,2012,6(3):77-79.
[16] Myers TG,Cui Q,Kuskowski M,et al.Outcomes of total and unicompartmental knee arthroplasty for secondary and spontaneous osteonecrosis of the knee[J].J Bone Joint Surg Am,2006,88(3):76-82.
[17] Marmor L.Unicompartmental arthroplasty for osteonecrosisof the knee joint[J].Clin Orthop Relat Res,1993,294(9):247-253.
[18] Radke S,Wollmerstedt N,Bischoff A,et al.Knee arthroplasty for spontaneous osteonecrosis of the knee:unicompartmental versus bicompartmental knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2005,13(3):158-162.
[19] 郭万首,张启栋,刘朝晖,等.膝关节单髁置换术治疗晚期膝关节自发性骨坏死[J].中华骨科杂志,2014,34(6):631-637.
[20] 马童,涂意辉,薛华明,等.牛津假体单髁置换术治疗膝关节自发性骨坏死初步研究[J].中国矫形外科杂志,2016,24(7):660-662.
[21] Parratte S,Argenson JN,Dumas J,et al.Unicompartmental knee arthroplasty for avascular osteonecrosis[J].Clin Orthop Relat Res,2007,464(1):82-89.
[22] Choy WS,Kim KJ,Lee SK,et al.Medial unicompartmental knee arthroplasty in patients with spontaneous osteonecrosis of the knee[J].Clin Orthop Surg,2011,3(4):279-284.
[23] Servien E,Verdonk PC,Lustig S,et al.Medial unicompartmental knee arthroplasty for osteonecrosis or osteoarthritis[J].Knee Surg Sports Traumatol Arthrosc,2008,16(11):1038-1042.
[24] Andrew J,Hemant P,Christopher A,et al.Oxford medial unicompartmental arthroplasty for focal spontaneous osteonecrosis of the knee[J].Acta Orthopaedica,2005,76(5):688-692.
[25] Tong M,Yihui T,Huaming X,et al.Unicompartmental knee arthroplasty for spontaneous osteonecrosis[J].J Orthop Surg,2017,25(1):1-5.

更新日期/Last Update: 1900-01-01