单髁置换与胫骨高位截骨治疗膝关节内侧间室骨关节炎:1年随访比较
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摘要
背景:膝关节内侧间室骨关节炎患者临床上经常会通过单髁置换或者胫骨高位截骨治疗,但选择胫骨高位截骨还是单髁置换更适合尚存争议。目的:探讨胫骨高位截骨与单髁置换治疗膝关节内侧间室骨关节炎的近期疗效。方法:纳入2016年5月至2017年8月收治的38例膝关节内侧间室骨关节炎患者,根据意愿原则分成2组,其中胫骨高位截骨组18例,单髁置换组20例。记录比较2组患者Tegner膝关节运动评分及Lysholm膝关节评分,评价关节功能恢复情况;根据膝关节负重位X射线片测定胫股角,评定膝关节各间室关节软骨退变情况。结果与结论:(1)术后2组患者手术切口均获得Ⅰ期愈合,并且均获得随访,胫骨高位截骨组随访时间为1.0-2.8年,单髁置换组为1.0-3.2年;(2)2组患者组内手术前后Tegner膝关节评分、Lysholm膝关节评分、胫股角比较,2组术后均能改善运动功能及矫正膝关节畸形,差异均有显著性意义(P <0.05);2组间各指标比较差异均无显著性意义(P> 0.05);(3)提示临床治疗膝关节内侧间室骨关节炎,无论是胫骨高位截骨还是单髁置换,均能获得满意的近期疗效,但中远期疗效有待进一步观察。
BACKGROUND: Patients with medial compartment osteoarthritis of the knee often receive unicompartmental knee arthroplasty or high tibial osteotomy treatment. However, which one is the optimal choice remains controversial.OBJECTIVE: To compare the short-term effectiveness of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of medial compartment osteoarthritis of the knee.METHODS: Thirty-eight patients with medial compartment osteoarthritis of the knee from May 2016 to August 2017 were enrolled. Eighteen patients were treated with high tibial osteotomy, and 20 patients were treated with unicompartmental knee arthroplasty. Tegner activity score and Lysholm knee score were compared to assess the functional recovery of knee joint. The femorotibial angle was measured on X-ray, and the cartilage degeneration of each compartment was evaluated.RESULTS AND CONCLUSION:(1) All incision healed primarily in both groups. All patients were followed up for 1.0-2.8 years in the high tibial osteotomy group and 1.0-3.2 years in the unicompartmental knee arthroplasty group.(2) There were significant differences in the Tegner activity score, Lysholm knee score, and femorotibial angle in the two groups before and after operation, showing that both groups could improve mobility function and correct deformity(P < 0.05). There was no significant difference in all above indexes between two groups(P > 0.05).(3) These results indicate that both high tibial osteotomy and unicompartmental knee arthroplasty can achieve good short-term effectiveness for treating medial compartment osteoarthritis of the knee; however, the long-term effectiveness needs further investigation.
BACKGROUND: Patients with medial compartment osteoarthritis of the knee often receive unicompartmental knee arthroplasty or high tibial osteotomy treatment. However, which one is the optimal choice remains controversial.OBJECTIVE: To compare the short-term effectiveness of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of medial compartment osteoarthritis of the knee.METHODS: Thirty-eight patients with medial compartment osteoarthritis of the knee from May 2016 to August 2017 were enrolled. Eighteen patients were treated with high tibial osteotomy, and 20 patients were treated with unicompartmental knee arthroplasty. Tegner activity score and Lysholm knee score were compared to assess the functional recovery of knee joint. The femorotibial angle was measured on X-ray, and the cartilage degeneration of each compartment was evaluated.RESULTS AND CONCLUSION:(1) All incision healed primarily in both groups. All patients were followed up for 1.0-2.8 years in the high tibial osteotomy group and 1.0-3.2 years in the unicompartmental knee arthroplasty group.(2) There were significant differences in the Tegner activity score, Lysholm knee score, and femorotibial angle in the two groups before and after operation, showing that both groups could improve mobility function and correct deformity(P < 0.05). There was no significant difference in all above indexes between two groups(P > 0.05).(3) These results indicate that both high tibial osteotomy and unicompartmental knee arthroplasty can achieve good short-term effectiveness for treating medial compartment osteoarthritis of the knee; however, the long-term effectiveness needs further investigation.
引文
[1]安雪军,王小健.膝骨关节炎两种截骨术的疗效比较[J].中国药物与临床,2015,15(11):1641-1642.
[2]尚延春,张海英,张江涛,等.胫骨高位截骨手术治疗膝内翻型骨性关节炎长期随访分析.中国矫形外科杂志,2007,15(13):973-975.
[3]祁昕征,张家铭,谭传明.从生物力学角度评价单髁置换术与腓骨截骨术[J].医用生物力学,2015,30(6):479-487.
[4]孔令俊,邓强,赵军,等.关节镜下有限清理术治疗膝骨性关节炎的疗效[J]甘肃医药,2013,32(4):296-297.
[5]Dunn AS,Petterson SC,Plancher KD.Unicondylar knee arthroplasty.Clin Sports Med.2014;33(1):87-104.
[6]Lim JW,Cousins GR,Clift BA,et al.Oxford unicompartmental knee arthro plasty versus age and gender matched total knee arthroplasty functional outcome and survivorship analysis.J Arthroplasty.2014;29(9):1779-1783.
[7]袁毅,马川,黄家俊.膝关节骨性关节炎的治疗进展[J].西部医学,2011,23(8):1600-1602.
[8]刘晓东,蔡珉巍,涂意辉.微创单髁置换术治疗膝关节内侧间室骨性关节炎的初步临床报告[J].中国矫形外科杂志,2010,18(7):548-552.
[9]Longo UG,Loppini M,Trovato U,et al.No difference between unicompartmental versus total knee arthroplasty for the management of medial osteoarthtritis of the knee in the same patient:a systematic review and pooling data analysis.Br Med Bull.2015;114(1):65-73.
[10]Costa CR,Johnson AJ,Mont MA,et al.Unicompartmental and total knee arthroplasty in the same patient.J Knee Surg.2011;24(4):273-278.
[11]Laurencin CT,Zelicof SB,Scott RD,et al.Unicompartmental versus total knee arthroplasty in the same patient.A comparative study.Clin Orthop Relat Res.1991;273(2):151-156.
[12]Nwachukwu BU,McCormick FM,Schairer WW,et al.Unicompartmental knee arthroplasty versus high tibial osteotomy:United States practice patterns for the surgical treatment of unicompartmental arthritis.J Arthroplasty.2014;29(8):1586-1589.
[13]Jones GG,Kotti M,Wiik AV,et al.Gait comparison of unicompartmental and total knee arthroplasties with healthy controls.Bone Joint J.2016;98-B(10 Suppl B):16-21.
[14]Maduekwe UI,Zywiel MG,Bonutti PM,et al.Scientific evidence for the use of modern unicompartmental knee arthroplasty.Expert Rev Med Devices.2010;7(2):219-239.
[15]Squire MW,Callaghan JJ,Goetz DD,et al.Unicompartmental knee replacement.A minimum 15 year follow up study.Clin Orthop Relat Res.1999;(367):61-72.
[16]Wong T,Wang CJ,Wang JW,et al.Functional outcomes of uni knee arthroplasty for medial compartment knee arthropathy in asian patients.Biomed J.2014;37(6):406-410.
[17]Soohood NF,Sharifi H,Kominski G,et al.Costefeetiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis.J Bone Joint Surg Am.2006;88(9):1975-1982.
[18]Maduekwe UI,Zywiel MG,Bonutti PM,et al.Scientific evidence for the use of modern unicompartmental knee arthroplasty.Expert Rev Med Devices.2010;7(2):219-239.
[19]刘志宏,张炅,何川,等.活动平台全膝关节假体和单髁膝关节假体置换术后的步态对比分析[J].中华关节外科杂志(电子版),2017,11(1):17-23.
[20]Pornrattanamaneewong C,Numkanisorn S,Chareancholvanich K,et al.A retrospective analysis of medial opening wedge hightibialosteotomy forvarus osteoarthritic knee.Indian J Orthop.2012;46(4):45.
[21]Rossi R,Bonasia DE,Amendola A,et al.The role of high tibial osteotomy in the varus knee.J Am Acad Orthop Surg.2011;19(10):590-599.
[22]黄将来.胫骨高位截骨术治疗内翻型膝骨性关节炎的效果分析[J].河南医学研究,2016,25(6):1042-1043.
[23]熊福军,贺西京,冯宏伟,等.关节镜下胫骨高位截骨治疗早期膝骨关节炎并内翻畸形疗效观察[J].现代中西医结合杂志,2014,23(4):389-390.
[24]Spahn G,Hofmann GO,von Engelhardt LV,et al.The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis:a meta-analysis.Knee Surg Sports Traumatol Arthrosc.2013;21(1):96-112.
[25]孔令俊,邓强,赵军,等.关节镜下有限清理术治疗膝骨性关节炎的疗效[J].甘肃医药,2013,32(4):296-297.
[26]Liu JS.Combined closing-wedge high tibial osteotomy with arthroscopy for varus knee and medial compartment osteoar-thritis:clinical results at a minimum follow-up for five years.Zhongguo Gu Shang.2013;26(9):748-752.
[27]Fu D,Li G,Chen K,et al.Comparison of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of unicompartmental osteoarthritis:a meta analysis.J Arthroplasty.2013;28(5):759-765.
[28]Schindler OS,Scott WN,Scuderi GR.The practice of unicompartmental knee arthroplasty in the United Kingdom.J Orthop Surg(Hong Kong).2010;8(3):312-319.
[29]Dettoni F,Bonasia DE,Castoldi F,et al.High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee a review of the literature.Iowa Orthop J.2010;30:131-140.
[30]杨波,姜鑫.单髁置换术与胫骨高位截骨术治疗膝关节内侧间室骨关节炎的近期疗效比较[J].中国修复重建外科杂志,2015,29(5):548-552.
[2]尚延春,张海英,张江涛,等.胫骨高位截骨手术治疗膝内翻型骨性关节炎长期随访分析.中国矫形外科杂志,2007,15(13):973-975.
[3]祁昕征,张家铭,谭传明.从生物力学角度评价单髁置换术与腓骨截骨术[J].医用生物力学,2015,30(6):479-487.
[4]孔令俊,邓强,赵军,等.关节镜下有限清理术治疗膝骨性关节炎的疗效[J]甘肃医药,2013,32(4):296-297.
[5]Dunn AS,Petterson SC,Plancher KD.Unicondylar knee arthroplasty.Clin Sports Med.2014;33(1):87-104.
[6]Lim JW,Cousins GR,Clift BA,et al.Oxford unicompartmental knee arthro plasty versus age and gender matched total knee arthroplasty functional outcome and survivorship analysis.J Arthroplasty.2014;29(9):1779-1783.
[7]袁毅,马川,黄家俊.膝关节骨性关节炎的治疗进展[J].西部医学,2011,23(8):1600-1602.
[8]刘晓东,蔡珉巍,涂意辉.微创单髁置换术治疗膝关节内侧间室骨性关节炎的初步临床报告[J].中国矫形外科杂志,2010,18(7):548-552.
[9]Longo UG,Loppini M,Trovato U,et al.No difference between unicompartmental versus total knee arthroplasty for the management of medial osteoarthtritis of the knee in the same patient:a systematic review and pooling data analysis.Br Med Bull.2015;114(1):65-73.
[10]Costa CR,Johnson AJ,Mont MA,et al.Unicompartmental and total knee arthroplasty in the same patient.J Knee Surg.2011;24(4):273-278.
[11]Laurencin CT,Zelicof SB,Scott RD,et al.Unicompartmental versus total knee arthroplasty in the same patient.A comparative study.Clin Orthop Relat Res.1991;273(2):151-156.
[12]Nwachukwu BU,McCormick FM,Schairer WW,et al.Unicompartmental knee arthroplasty versus high tibial osteotomy:United States practice patterns for the surgical treatment of unicompartmental arthritis.J Arthroplasty.2014;29(8):1586-1589.
[13]Jones GG,Kotti M,Wiik AV,et al.Gait comparison of unicompartmental and total knee arthroplasties with healthy controls.Bone Joint J.2016;98-B(10 Suppl B):16-21.
[14]Maduekwe UI,Zywiel MG,Bonutti PM,et al.Scientific evidence for the use of modern unicompartmental knee arthroplasty.Expert Rev Med Devices.2010;7(2):219-239.
[15]Squire MW,Callaghan JJ,Goetz DD,et al.Unicompartmental knee replacement.A minimum 15 year follow up study.Clin Orthop Relat Res.1999;(367):61-72.
[16]Wong T,Wang CJ,Wang JW,et al.Functional outcomes of uni knee arthroplasty for medial compartment knee arthropathy in asian patients.Biomed J.2014;37(6):406-410.
[17]Soohood NF,Sharifi H,Kominski G,et al.Costefeetiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis.J Bone Joint Surg Am.2006;88(9):1975-1982.
[18]Maduekwe UI,Zywiel MG,Bonutti PM,et al.Scientific evidence for the use of modern unicompartmental knee arthroplasty.Expert Rev Med Devices.2010;7(2):219-239.
[19]刘志宏,张炅,何川,等.活动平台全膝关节假体和单髁膝关节假体置换术后的步态对比分析[J].中华关节外科杂志(电子版),2017,11(1):17-23.
[20]Pornrattanamaneewong C,Numkanisorn S,Chareancholvanich K,et al.A retrospective analysis of medial opening wedge hightibialosteotomy forvarus osteoarthritic knee.Indian J Orthop.2012;46(4):45.
[21]Rossi R,Bonasia DE,Amendola A,et al.The role of high tibial osteotomy in the varus knee.J Am Acad Orthop Surg.2011;19(10):590-599.
[22]黄将来.胫骨高位截骨术治疗内翻型膝骨性关节炎的效果分析[J].河南医学研究,2016,25(6):1042-1043.
[23]熊福军,贺西京,冯宏伟,等.关节镜下胫骨高位截骨治疗早期膝骨关节炎并内翻畸形疗效观察[J].现代中西医结合杂志,2014,23(4):389-390.
[24]Spahn G,Hofmann GO,von Engelhardt LV,et al.The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis:a meta-analysis.Knee Surg Sports Traumatol Arthrosc.2013;21(1):96-112.
[25]孔令俊,邓强,赵军,等.关节镜下有限清理术治疗膝骨性关节炎的疗效[J].甘肃医药,2013,32(4):296-297.
[26]Liu JS.Combined closing-wedge high tibial osteotomy with arthroscopy for varus knee and medial compartment osteoar-thritis:clinical results at a minimum follow-up for five years.Zhongguo Gu Shang.2013;26(9):748-752.
[27]Fu D,Li G,Chen K,et al.Comparison of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of unicompartmental osteoarthritis:a meta analysis.J Arthroplasty.2013;28(5):759-765.
[28]Schindler OS,Scott WN,Scuderi GR.The practice of unicompartmental knee arthroplasty in the United Kingdom.J Orthop Surg(Hong Kong).2010;8(3):312-319.
[29]Dettoni F,Bonasia DE,Castoldi F,et al.High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee a review of the literature.Iowa Orthop J.2010;30:131-140.
[30]杨波,姜鑫.单髁置换术与胫骨高位截骨术治疗膝关节内侧间室骨关节炎的近期疗效比较[J].中国修复重建外科杂志,2015,29(5):548-552.
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