膝前痛和髌股关节退变对膝关节内侧间室单髁置换术的治疗效果影响

发布时间：2018-03-01 21:02

本文关键词： 髌股关节退变膝前痛膝关节单髁置换术(UKA)　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:随着人类生活环境及生活习惯的不断改变,中老年人膝关节骨性关节炎的发病率仅次于糖尿病高血压病等中老年人常见疾病,然而超过半数的膝关节骨性关节炎的病变部位大部分局限于膝关节内侧间室。目前膝关节单髁置换术(UKA Unicompartmental Knee Arthroplasty)被认为是治疗中老年患者膝关节骨性关节炎内侧间室病变的最好选择,特别是微创单髁置换术。因为UKA与全膝关节置换术(TKA Total Knee Arthroplasty)相比,具有创伤小、死亡率低及并发症发生率低等优点,更能减少患者的痛苦,更接近膝关节的生理解剖结构[1-4]。然而UKA的手术适应症目前还不是很明确,其中很多研究认为髌股关节炎应该是UKA的禁忌证,也有很多学者认为这个观点是错误的。曾经有研究称髌股关节炎是UKA翻修最常见的原因[5-8]。另外,也有一些学者研究表明术前髌股关节是否存在退变并不影响UKA术后疗效,所以,他们认为是行UKA治疗时,特别是采用活动平台的假体,可以不考虑髌股关节的退变情况[9-11]。目的:研究膝前痛和髌股关节退变对治疗膝关节内侧关节炎行膝关节内侧间室单髁置换术(UKA)的术后治疗效果的影响。方法:回顾性分析2013年7月至2015年7月期间,大连医科大学附属第二医院关节外科为治疗膝关节内侧膝关节炎行膝关节内侧单髁置换手术(UKA)的86例膝(83个患者)。其中男性患膝15例,女性患膝71例;年龄42~81岁,平均66.3岁。患者体重指数(BMI)23~27 kg/m2,平均25.3 kg/m2。根据患者术前是否存在膝前疼痛,将选取患者分为膝前疼痛组和无膝前疼痛组。术前采用Altman分级和Ahlback评分分别对这86例膝关节术前髌股关节影像学退变情况进行评估,将患膝分为内侧正常组、内侧退变组、外侧正常组、外侧退变组。采用牛津膝关节评分(OKS评分)、美国膝关节学会评分(AKS评分)对术前和术后膝关节疼痛情况及功能进行评分。采用SPSS软件对术前与术后末次随访时膝关节AKS、OKS得分进行独立样本t检验分析,用均数±标准差(喁±s)表示。结果:所有本研究选取的患者均获得了完整的随访,随访时间为12—24个月,平均15.6个月。所有选取的患者术后均无感染、聚乙烯衬垫脱位、假体位置不良或松动、假体周围骨折等并发症。所有选取的患者术后末次随访时OKS、AKS得分较有术前均显著改善(P0.01)。将选取的患者进行分组,膝前疼痛组42例,无膝前痛组44例,两组术前OKS、AKS得分分别进行比较,差异均无统计学意义(P0.05);两组末次随访时OKS、AKS得分分别进行比较,差异均无统计学意义(P0.05)。根据Ahlback和Altman评估髌股关节退变的情况,将所选患者进行分组。内侧髌股关节正常53例,内侧髌股关节退变33例;外侧髌股关节正常74例,外侧髌股关节退变12例(根据Altman评分)。内侧髌股关节正常77例,内侧髌股关节退变9例;外侧髌股关节正常80例,外侧髌股关节退变6例(根据Ahlback分级)。根据Ahlback和Altman评估,患者术前无论是否存在髌股关节退变,末次随访时OKS、AKS得分较术前均有显著改善(P0.01),有无内侧髌股关节退变表现的两组患者术前OKS、AKS得分之间进行比较,术后末次随访OKS、AKS得分之间进行比较,结果显示差异均无统计学意义(P0.05)。根据Ahlback分级,有无髌股关节外侧退变表现的两组患者术前OKS、AKS得分之间进行比较,术后末次随访时OKS、AKS得分之间进行比较,差异均无统计学意义;根据Altman评分,有无外侧髌股关节退变的两组患者术前OKS、AKS得分之间进行比较,差异无统计学意义;术后末次随访时,两组患者的OKS得分之间进行比较,差异也无统计学意义,但是末次随访时外侧髌股关节退变患者的AKS得分要低于无外侧髌股关节退变患者的AKS得分,而且差异有统计学意义(-2.47,-2.06 P=0.020.05)。结论:膝前痛和髌股关节内侧退变不影响膝关节内侧间室单髁置换术的治疗效果,而髌股关节外侧退变的患者行膝关节内侧间室单髁置换术的治疗效果要比髌股关节外侧正常的患者的治疗效果差。
[Abstract]:Background: with the continuous change of the human living environment and living habits, the incidence of elderly knee osteoarthritis rate after common disease hypertension and diabetes in the elderly, but more than half of the lesion of knee osteoarthritis was largely confined to the medial knee compartment. The unicompartmental knee arthroplasty (UKA Unicompartmental Knee Arthroplasty) is considered to be the best choice in the treatment of elderly patients with knee osteoarthritis of the medial compartment lesions, especially minimally invasive unicompartmental arthroplasty. Because the UKA and total knee arthroplasty (TKA Total Knee Arthroplasty) compared with small trauma, low mortality rate and low complication rate, better to reduce the suffering of patients, closer to the physiological knee anatomy [1-4]. however UKA indications for surgery is still not very clear, many of them think of patellofemoral off Arthritis should be a contraindication to UKA, there are many scholars believe that this view is wrong. Once called patellofemoral arthritis is the most common cause of [5-8]. UKA revision in addition, there are also some scholars study shows that preoperative patellofemoral degeneration does not affect the existence of UKA postoperative curative effect, so they think is UKA at the time of treatment, especially the prosthesis of the movable platform, can not consider the patellofemoral degeneration of [9-11]. Objective: To study the anterior knee pain and degeneration of the patellofemoral joint treatment of medial knee arthritis of knee joint medial unicompartmental arthroplasty (UKA) effect after surgery. Methods: a retrospective analysis of July 2013 to July 2015, joint surgery, Second Affiliated Hospital of Dalian Medical University for treatment of medial knee osteoarthritis knee joint medial unicompartmental arthroplasty (UKA) of 86 cases of knee (83 patients). The 15 men suffering from knee Cases of female knee in 71 cases; age 42~81 years old, average 66.3 years old. The body mass index (BMI) of 23~27 kg/m2, an average of 25.3 kg/m2. according to whether patients with anterior knee pain, the selected patients were divided into anterior knee pain group and anterior knee pain score group. Of the 86 cases of knee joint surgery the patellofemoral joint degeneration were evaluated by Altman grading and Ahlback before operation, will be divided into medial knee medial degeneration group, normal group, normal group, lateral, lateral degeneration group. Using the Oxford knee score (OKS score), American Knee Society score (AKS score) score of joint function and knee pain before and after surgery. The preoperative and final follow-up after operation of knee joint AKS by SPSS software, the OKS score was analyzed by independent sample t test, standard deviation (Yong + s). Results: all the study selected the patients got complete follow-up follow-up. The time is 12 to 24 months, average 15.6 months. All the patients had no infection, dislocation of the polyethylene liner, implant malposition or loosening, periprosthetic fracture and other complications. At the end of the follow-up of all selected patients after OKS, AKS score before surgery were significantly improved (P0.01). The selected patients were divided into two groups, anterior knee pain group of 42 patients without anterior knee pain group 44 cases, two groups of preoperative OKS, AKS scores were compared, there were no significant differences between the two groups (P0.05); at the end of the follow-up OKS, AKS scores were compared, the differences were not statistically significant (P0.05 Ahlback and Altman). According to the assessment of patellofemoral joint degeneration, the selected patients were divided into two groups. The medial patellofemoral joint was normal in 53 cases, 33 cases of medial patellofemoral degeneration; lateral patellofemoral joint was normal in 74 cases, 12 cases of patellofemoral joint degeneration (according to the Altman score). The medial patellofemoral joint in 77 cases of normal. 9 cases of lateral patellofemoral degeneration; lateral patellofemoral joint was normal in 80 cases, 6 cases of patellofemoral joint degeneration (according to the Ahlback classification). According to Ahlback and Altman in patients with preoperative assessment, regardless of the existence of patellofemoral degeneration, at the end of the follow-up OKS, AKS scores were significantly improved compared with the preoperative (P0.01), there are no patients the two group OKS medial patellofemoral degeneration performance, compare the AKS score, postoperative follow-up were compared between OKS, AKS scores, results showed that there were no significant differences (P0.05). According to Ahlback classification, there are two groups of patients with OKS before the lateral patellofemoral joint degeneration, compared to AKS the score between the last follow-up after operation were compared between OKS, AKS score, there were no significant differences; according to the Altman score, there are two groups of patients with OKS before patellofemoral joint degeneration, AKS scores were compared, the difference was not statistically significant ; at the end of the follow-up after operation, were compared between the two groups of patients with OKS score, there was no significant difference, but at the end of the follow-up lateral patellofemoral joint degeneration in patients with AKS score lower than the non lateral patellofemoral degeneration in patients with AKS score, and the difference was statistically significant (-2.47, -2.06, P=0.020.05). Conclusion: the knee the pain and the medial patellofemoral degeneration does not affect the knee joint medial compartment unicompartmental arthroplasty treatment, while the patients of knee joint medial patellofemoral degenerative lateral compartment unicompartment arthroplasty in the treatment of patellofemoral lateral effect than normal in patients with poor therapeutic effect.

【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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