膝关节单髁置换治疗单间室膝关节骨性关节炎的初期疗效观察
发布时间：2018-08-27 10:01
【摘要】：研究背景:膝关节骨性关节炎是一种常见的疾病。骨性关节炎是引起膝关节疼痛的主要原因之一。膝关节骨性关节炎曾被认为是老年性退行性疾病。但根据近年的研究认为,膝关节骨性关节炎病理形态上的改变主要为局限性、进行性关节软骨破坏及关节边缘的骨赘形成,而骨赘实际是一种修复的表现。同时进行截骨术改变关节负重后,骨性关节炎则出现修复现象,所以现在认为膝关节骨性关节炎并不是退行性病变。膝关节单髁置换术(Unicondylar Knee Arthroplasty,UKA)主要目的是替代膝关节胫骨、股骨受破坏的软骨表面。单髁置换适用于单间室的骨关节炎或骨坏死,放射学检查提示对侧间隔可以保留且髌骨关节未受累或只是轻度退行性病变。目的:本文通过对膝关节单髁置换术(UKA)治疗单间室骨关节骨性关节炎患者的初期临床观察,进一步明确UKA的临床疗效。方法:筛选我院2012-2015年内侧间室骨关节病行膝关节患者单髁置换术30例,术后1、3、6、12个月,此后每年门诊随访一次,复查膝关节X线片并记录疗效评分及并发症发生情况。患者术前、术后临床与影像学资料均被保留。疗效评价方法:美国KSS临床与功能评分(优:85~100分,良:70~84分,可:60~69分,差:60分)。观察比较术前和术后末次随访时所得(Hospital for Special Surgery,HSS)HSS评分、股胫角(FTA)、胫骨平台后倾角(STA)、最大关节活动度之间的差异。疗效评估者为非实行手术医师。采用SPSS23.0统计软件,对手术前后膝关节KSS临床与HSS评分,计量数据采用配对t检验,P0.05为差异有统计学意义。结果:本组患者30例通过采用膝关节单髁置换术治疗,优17例(占56.67%),良11例(占36.67%),可2例(6.66%),差0例。患者HSS评分由术前平均(61.28±4.76)分提高至术后平均(89.28±3.68)分。患者术后股胫角(FTA)、胫骨平台后倾角(STA)较术前明显减小,HSS评分及最大关节屈伸活动度方面明显优于术前,与术前比较明显改善,差异均有统计学意义(P0.05)。所有患肢术后未出现刀口感染、下肢深静脉血栓形成、肺栓塞、假体周围骨折等并发症。结论:经人工膝关节单髁置换术后HSS评分膝关节功能及影像学评估证实,人工膝关节单髁置换术是一种安全有效的治疗单间室骨性膝关节炎的方法。
[Abstract]:Background: osteoarthritis of knee joint is a common disease. Osteoarthritis is one of the main causes of knee pain. Osteoarthritis of the knee joint was once considered to be a senile degenerative disease. However, according to recent studies, the pathological changes of osteoarthritis of the knee are mainly limited, progressive destruction of articular cartilage and formation of osteophyte on the edge of the joint, and osteophyte is actually a sign of repair. At the same time osteotomy changes the weight of the joint, osteoarthritis appears repair phenomenon, so now it is considered that knee osteoarthritis is not a degenerative disease. Single condyle replacement (Unicondylar Knee Arthroplasty,UKA) is designed to replace the damaged cartilage surface of the tibia and femur of the knee. Single condyle replacement is suitable for osteoarthritis or osteonecrosis in single chamber. Radiologic examination shows that the contralateral septum can be preserved and patellar joint is not involved or only slightly degenerative. Objective: to investigate the clinical effect of (UKA) in the treatment of osteoarthritis of single compartment osteoarthritis (Osteoarthritis) with single condyle replacement (UKA). Methods: 30 patients with medial interventricular osteoarthropathy underwent single condylar replacement from 2012 to 2015 in our hospital. The patients were followed up every year for 6 months and 12 months after operation. The curative effect score and complications were recorded. Preoperative and postoperative clinical and imaging data were preserved. Methods: clinical and functional score of KSS in USA (excellent: 85 ~ 100, good: 7084, May: 6069, poor: 60). To observe and compare the difference of (Hospital for Special Surgery,HSS) HSS score before and after the last follow-up and the maximum range of joint motion of tibial plateau posterior dip angle (STA), in tibial angle of femur and tibial angle. The curative effect is evaluated by non-performing surgeon. SPSS23.0 statistical software was used to evaluate the clinical and HSS scores of knee joint KSS before and after operation. There was statistical significance in measuring data by pairing t test (P0.05). Results: 30 cases were treated by single condylar replacement of knee joint, 17 cases were excellent (56.67%), 11 cases were good (36.67%), 2 cases were fair (6.66%), and 0 cases were poor. The HSS score of the patients increased from (61.28 卤4.76) to (89.28 卤3.68). Postoperative tibial angle (FTA), tibial plateau posterior dip (STA) was significantly lower than the preoperative score and the maximum joint flexion and extension activities were significantly better than before compared with preoperative significantly improved the difference was statistically significant (P0.05). No incision infection, deep vein thrombosis, pulmonary embolism, periprosthetic fracture were found in all the affected limbs. Conclusion: the HSS score of knee joint function and imaging evaluation after single condylar arthroplasty proved that single condylar arthroplasty is a safe and effective method for the treatment of single compartment osteoarthritis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
本文编号：2206946
[Abstract]:Background: osteoarthritis of knee joint is a common disease. Osteoarthritis is one of the main causes of knee pain. Osteoarthritis of the knee joint was once considered to be a senile degenerative disease. However, according to recent studies, the pathological changes of osteoarthritis of the knee are mainly limited, progressive destruction of articular cartilage and formation of osteophyte on the edge of the joint, and osteophyte is actually a sign of repair. At the same time osteotomy changes the weight of the joint, osteoarthritis appears repair phenomenon, so now it is considered that knee osteoarthritis is not a degenerative disease. Single condyle replacement (Unicondylar Knee Arthroplasty,UKA) is designed to replace the damaged cartilage surface of the tibia and femur of the knee. Single condyle replacement is suitable for osteoarthritis or osteonecrosis in single chamber. Radiologic examination shows that the contralateral septum can be preserved and patellar joint is not involved or only slightly degenerative. Objective: to investigate the clinical effect of (UKA) in the treatment of osteoarthritis of single compartment osteoarthritis (Osteoarthritis) with single condyle replacement (UKA). Methods: 30 patients with medial interventricular osteoarthropathy underwent single condylar replacement from 2012 to 2015 in our hospital. The patients were followed up every year for 6 months and 12 months after operation. The curative effect score and complications were recorded. Preoperative and postoperative clinical and imaging data were preserved. Methods: clinical and functional score of KSS in USA (excellent: 85 ~ 100, good: 7084, May: 6069, poor: 60). To observe and compare the difference of (Hospital for Special Surgery,HSS) HSS score before and after the last follow-up and the maximum range of joint motion of tibial plateau posterior dip angle (STA), in tibial angle of femur and tibial angle. The curative effect is evaluated by non-performing surgeon. SPSS23.0 statistical software was used to evaluate the clinical and HSS scores of knee joint KSS before and after operation. There was statistical significance in measuring data by pairing t test (P0.05). Results: 30 cases were treated by single condylar replacement of knee joint, 17 cases were excellent (56.67%), 11 cases were good (36.67%), 2 cases were fair (6.66%), and 0 cases were poor. The HSS score of the patients increased from (61.28 卤4.76) to (89.28 卤3.68). Postoperative tibial angle (FTA), tibial plateau posterior dip (STA) was significantly lower than the preoperative score and the maximum joint flexion and extension activities were significantly better than before compared with preoperative significantly improved the difference was statistically significant (P0.05). No incision infection, deep vein thrombosis, pulmonary embolism, periprosthetic fracture were found in all the affected limbs. Conclusion: the HSS score of knee joint function and imaging evaluation after single condylar arthroplasty proved that single condylar arthroplasty is a safe and effective method for the treatment of single compartment osteoarthritis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
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