单髁置换术胫骨假体内外翻角对术后近期疗效影响的临床研究

发布时间：2018-01-26 11:18

本文关键词： 单髁牛津膝胫骨假体内外翻角临床疗效　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:评价诊断为膝关节前内侧关节炎(Anteromedial Osteoarthtitis)患者在接受牛津膝单髁置换术(Oxford Unicompartmental Knee Arthroplasty,OUKA)后,术后随访的膝关节X线片上胫骨假体冠状面影像学结果对术后临床效果的影响。资料和方法:从2013年7月至2016年6月,从大连医科大学附属第二医院共收治的141例膝关节内侧间室骨关节炎、创伤性关节炎、自发性骨坏死等患者中,按照纳入、剔除标准,筛选129人(172膝)前内侧关节炎患者纳入本回顾性研究。术前完整记录患者的HSS评分(the Hospital for Special Surgery Knee Score,HSS)和膝关节活动度(Range Of Knee Motion,ROM)。术后电话告知患者回本院门诊随诊,每次随诊记录患者的HSS评分和关节活动度。按照牛津膝关节操作手册,分别由2名医师对UKA患者术后的X线影像学图像,采用“Radi Ant DICOM Viewer”软件进行影像学测量股骨假体内外翻角(A角)、股骨假体屈伸角(B角)、胫骨假体内外翻角(E角)和胫骨平台后倾角(F角)。保证将A、B、F角在目标范围内,将胫骨假体内外翻角测量结果按2°为一个间隔进行分组,并根据结果范围,将胫骨假体内外翻角从-5°~6.35°分为6组(-5°~-3°组、-3°~-1°组、-1°~1°组、1°~3°组、3°~5°组和5°~7°组)。计量资料HSS评分和关节活动度(Range Of Motion,ROM)使用均值±标准差表示,术前术后比较采用配对t检验,E角各组间比较采用方差分析。比较异常值组和正常值组间差异,和比较内翻组与外翻组间差异采用t检验。结果:本研究共计129人(172膝),男22人(30膝),女107人(142膝),其中左膝91例、右膝81例。随访时间1~34个月,平均随访时间为15.7个月。期间无一人死亡,无一人失随访。124膝满足分组要求,术前平均ROM 109.23°(90°~135°),术后平均ROM 122.61°(90°~144°),术前和术后的ROM具有明显统计学差异。术前平均HSS评分61.17分(39分~84分),术后平均HSS评分89.62分(67.3分~100分),术后HSS评分较术前明显改善。比较胫骨假体内外翻角的各分组时,术后ROM未见统计学差异,术后HSS评分具有差异,5°~7°组相比-5°~5°内五组间的HSS评分明显降低(P㩳0.05),而五组相互之间无统计学差异(P0.05)。比较内翻组(89.82±5.02)和外翻组(89.12±7.10)之间的术后HSS评分和ROM未见统计学差异。结论:(1)应用Oxford phase 3代单髁假体,胫骨假体内外翻角处于内翻5°~外翻5°间时短期临床效果满意。(2)胫骨假体内外翻角超过外翻5°明显影响临床效果。
[Abstract]:Objective: to evaluate the patients with anterior medial knee joint arthritis diagnosed as Anteromedial Osteoartitis undergoing Oxford knee monondylar replacement. Oxford Unicompartmental Knee Arthroplasty. Data and methods: from July 2013 to June 2016, the effect of coronal imaging results of tibial prosthesis on X ray radiographs of the knee joint was observed after OUKA. data and methods: from July 2013 to June 2016. 141 cases of medial compartment osteoarthritis, traumatic arthritis and spontaneous osteonecrosis of knee joint were treated in the second affiliated Hospital of Dalian Medical University. Patients with anterior medial arthritis were selected for this retrospective study. The HSS score of the patients was recorded before operation (P < 0.05). The Hospital for Special Surgery Knee Score. HSS) and range of Knee motion.After operation, the patients were informed by telephone to return to our outpatient clinic to follow up. According to the Oxford knee Joint Operations Manual, two physicians performed X-ray images of patients with UKA after operation. The Radi Ant DICOM Viewer software was used to measure the angle A of the femoral prosthesis and the angle of flexion and extension of the femoral prosthesis. The angle of tibial prosthesis (E) and the posterior inclination angle of tibial plateau are kept in the target range, and the measurement results of the tibial prosthesis's internal and external inversion angle are grouped at 2 掳as an interval. According to the range of results, the tibial prosthesis was divided into 6 groups from -5 掳to 6.35 掳. The mean 卤standard deviation was used to measure the HSS score and the range of motion of joint motion in 3 掳5 掳and 5 掳7 掳groups. Analysis of variance was used to compare the preoperation and postoperative differences between the abnormal value group and the normal value group. T test was used to compare the difference between the varus group and the valgus group. Results: in this study, there were 129 patients with varus and 172 knees, 22 males with 30 knees and 107 females with 142 knees, including 91 patients with left knee. 81 cases of right knee were followed up for 1 ~ 34 months, with an average follow-up time of 15.7 months. The average ROM was 109.23 掳/ 90 掳/ #number0# 掳/ min before operation and 122.61 掳/ 90 掳/ 90 掳/ 144 掳after operation respectively. The mean preoperative HSS score was 61.17 (39 / 84). The average HSS score was 89.62 (67.3 ~ 100). The postoperative HSS score was significantly improved than that before operation. There was no statistical difference in ROM after operation. The HSS score of 5 掳~ 7 掳group was significantly lower than that of -5 掳~ 5 掳group, and the HSS score of 5 掳~ 7 掳group was significantly lower than that of 5 掳~ 5 掳group. 0.05). There was no statistical difference among the five groups (P 0.05). The comparison between the varus group (89.82 卤5.02) and the valgus group (89.12 卤7.10). There was no significant difference in HSS score and ROM between the two groups. Conclusion: 1) Oxford phase 3 single condylar prosthesis is used. The short term clinical effect of tibial prosthesis was satisfactory when the external and internal rotation angle of tibial prosthesis was between 5 掳and 5 掳) the tibial prosthesis had a significant effect on the clinical effect when the angle of external and internal varus of tibial prosthesis exceeded that of valgus 5 掳.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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