牛津单髁置换术治疗膝内侧间室骨性关节炎的近期疗效

发布时间：2018-06-29 08:29

本文选题：骨性关节炎 + 膝关节单髁置换术(UKA)　；参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：牛津单髁假体系统作为疗效可靠的单髁关节之一,在国内已经得到广泛开展。本文主要探讨使用牛津第三代单髁系统治疗膝关节内侧间室骨性关节炎的患者术后下肢力线改变与近期疗效。方法：回顾性分析从2014年12月至2015年12月在广东省中医院关节科行膝关节牛津单髁置换术治疗的38例(38膝)膝关节内侧间室病变患者,其中男10例10膝,女28例28膝；平均年龄66岁(52-79岁)；平均体重66kg(48-90kg)；术后随访3-14月,平均8.8月。全部病例均由同一主刀完成,使用第三代牛津膝单髁假体系统,行膝关节内侧髁置换,采取微创UKA小切口技术。收集统计患者手术时间、术中出血量、围手术期是否输血、术后住院时间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,简称HSS评分)、美国膝关节协会评分(American knee society knee score,简称KSS评分)。采用SPSS18.0软件对数据进行处理和统计学方法分析((P0.05认为具有统计学意义)。结果：38例(38膝)患者手术时间平均为：76.6(60-90)min,术中出血量：52.6m,术后住院天数平均为7.8天(7-10天),所有患者手术切口均为甲级愈合。围手术期内,所有患者均无输血,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8.8月(3-14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173.65±3.55°,术后为177.50±1.37°；术前FTA平均为180.01±4.16°,术后平均为175.39±5.91。；术后膝关节最大活动度从术前的98.0±7.8°增长至术后的109.7±7.9°,以上数据,术前与术后相比,差异均具有统计学意义(P0.05)。术前和末次随访膝关节KSS临床评分分别为61.3±10.0和89.7±4.0；KSS功能评分分别为58.3±7.3和83.2±7.1；术前和末次随访时膝关节HSS评分分别为67.2±5.8和88.6±5.0,三组评分,术前和末次随访相比,差异均有统计学意义(P0.05)。结论：研究结果表明,对于膝关节内侧间室病变的患者,利用第三代牛津单髁系统,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的观察。
[Abstract]:Objective: Oxford single condylar prosthesis system, as one of the reliable single condylar joints, has been widely carried out in China. This paper mainly discusses the change of lower limb force line and the short term effect after the operation of the third generation single condylar system of Oxford in the treatment of the medial compartment osteoarthritis of the knee joint. A retrospective analysis from December 2014 to 1 is a retrospective analysis. In February, 38 patients (38 knees) with medial compartment lesions of the knee joint treated with Oxford single condylar replacement of the knee joint in Guangdong Province Traditional Chinese Medical Hospital, including 10 males and 10 knees, 28 women and 28 knees, mean age 66 (52-79 years) and average weight of 66kg (48-90kg), followed up for 3-14 months with an average of 8.8 months. All cases were completed by the same main knife and used third. On behalf of the Oxford knee single condylar prosthesis system, the medial condyle of the knee joint was replaced by the medial condyle of the knee joint, and the minimally invasive UKA small incision technique was adopted. The data of the operation time, the amount of bleeding in the operation, the perioperative blood transfusion, the postoperative hospital time and other data were analyzed, and the postoperative complications were observed and the X-ray films of the affected side of the knee joint were performed before and after the operation. The tibial angle (femorotibial angle, FTA), hip knee - ankle angle (hip-knee-ankle angle, HKA), the maximum activity of the knee joint (range of motion, ROM) were measured before and after the operation, and the knee joint score of the knee joint in American Special Surgery Hospital was evaluated before and at the last follow-up (hospital for). Ry knee score, referred to as HSS score), American Knee association score (American Knee Society knee score, referred to as KSS score). Using SPSS18.0 software for data processing and statistical analysis ((P0.05 think statistically). Results: 38 patients (38 knees) had an average operation time of 76.6 (60-90). The average number of days after operation was 7.8 days (7-10 days). All the patients were healed in the first stage. During the perioperative period, all the patients had no blood transfusion, no infection, pulmonary embolism, deep vein thrombosis of the lower limbs, iatrogenic neurovascular injury, periprosthetic fracture and other perioperative complications. The average follow-up was 8.8 months (3-14 months) and the quality of life of the patients. No aseptic prosthesis loosening, unexplained pain, polyethylene liner dislocation and other complications were found in all cases. The preoperative HKA was 173.65 + 3.55 degrees and 177.50 + 1.37 degrees after operation. The average FTA was 180.01 + 4.16 degrees before operation, and the average after operation was 175.39 + 5.91.. The maximum knee joint activity after operation increased from 98 + 7.8 degrees before the operation. The differences were statistically significant (P0.05) before and after operation (P0.05). The clinical scores of knee joint KSS before and at the last follow-up were 61.3 + 10 and 89.7 + 4, respectively, and KSS functional scores were 58.3 + 7.3 and 83.2 + 7.1, respectively, and the knee joint HSS scores were 67.2 + 5.8 and 88.6 + 5. respectively at the last and last follow-up. 0, three groups, the differences were statistically significant (P0.05). Conclusion: the results showed that the patients with medial compartment lesions of the knee joint were treated with third generation Oxford single condyle system and minimally invasive single condyle technique, with small trauma, less bone removal, short operation time, less blood loss, and postoperative stay. The hospital time is short, the complications are few, the postoperative recovery is fast, the joint activity is great, and the noumenon feeling is good. The short-term effect after the operation is satisfactory, the lower limb force line is improved obviously, and the long-term effect needs further observation.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.4

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