中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (30): 4793-4798.doi: 10.12307/2021.263

• 人工假体 artificial prosthesis • 上一篇    下一篇

单髁置换优于开式胫骨高位截骨：力学参数及膝关节功能的差异

林晓东，刘文刚，许学猛，刘  欣，卢  超，宋  敏，李聪聪   

  1. 广州中医药大学附属广东省第二中医院，广东省广州市   510095
  • 收稿日期:2020-11-19 修回日期:2020-11-21 接受日期:2021-01-07 出版日期:2021-10-28 发布日期:2021-07-29
  • 通讯作者: 刘文刚，博士，主任医师，广州中医药大学附属广东省第二中医院，广东省广州市 510095
  • 作者简介:林晓东，男，1993年生，2020年广州中医药大学毕业，硕士，医师，主要从事关节外科方面的研究
  • 基金资助:
    广东省中医药局科研项目(20183001)，负责人：刘文刚；广东省中医药局科研项目(20191021)，负责人：卢超；广州市科技计划项目(202002030204)，负责人：刘文刚

Unicompartmental knee arthroplasty superior to open-wedge high tibial osteotomy: differences of mechanical parameters and knee function

Lin Xiaodong, Liu Wengang, Xu Xuemeng, Liu Xin, Lu Chao, Song Min, Li Congcong   

  1. Guangdong Second Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510095, Guangdong Province, China; 
  • Received:2020-11-19 Revised:2020-11-21 Accepted:2021-01-07 Online:2021-10-28 Published:2021-07-29
  • Contact: Liu Wengang, MD, Chief physician, Guangdong Second Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510095, Guangdong Province, China
  • About author:Lin Xiaodong, Master, Physician, Guangdong Second Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510095, Guangdong Province, China
  • Supported by:
    the Scientific Research Project of Guangdong Bureau of Traditional Chinese Medicine, No. 20183001 (to LWG), No. 20191021 (to LC); the Science and Technology Project of Guangzhou, No. 202002030204 (to LWG)

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摘要：

文题释义：
单髁置换：常用于膝关节内侧间室的置换，为保膝手术，置换过程中保留了膝关节的韧带功能，最大限度地保留膝关节的本体感觉，且具有手术创伤小、恢复快的特点。
力学参数：此文观察的力学参数包括胫骨后倾角、髌骨高度及髋-膝-踝角。胫骨后倾角用以描述膝关节胫骨平台的矢状位形态，其大小代表胫骨平台的陡峭或平缓程度；髋-膝-踝角表示膝关节内、外翻程度；髌骨高度是髌骨相对于胫骨上端或股骨远端的距离。
背景：虽然胫骨高位截骨与单髁置换常被用于治疗单间室病变的内翻膝骨关节炎，但两者术后不同时期的膝关节功能是否存在差异，术前、术后的影像学参数是否有变化，仍需进一步的临床研究。
目的：比较单髁置换与开式胫骨高位截骨治疗单间室病变的内翻膝骨关节炎的早期临床疗效及膝关节影像学参数的差异。
方法：回顾性分析126例有单间室病变的内翻膝骨关节炎患者的病历资料，其中60例接受结节上开式胫骨高位截骨治疗，66例接受单髁置换治疗。采用美国特种外科医院评估两组患者术前、术后1个月及末次随访的膝关节功能；分别拍摄术前、术后下肢全长站立位X射线片及膝关节正侧位X射线片，测量患者术后髋-膝-踝角、胫骨后倾角、髌骨高度，对比术前、术后两组患者膝关节相关参数的差异。
结果与结论：①结果共纳入53例胫骨高位截骨患者和61例单髁置换患者，总体随访时长(26.29±3.84)个月；②术后1个月，单髁置换组的美国特种外科医院评分高于胫骨高位截骨组(P < 0.05)；但末次随访时，两组间美国特种外科医院评分相比差异无显著性意义(P > 0.05)；③与同组术前相比，胫骨高位截骨组的髋-膝-踝角、胫骨后倾角均增大(P < 0.05)，但髌骨高度值减小(P < 0.05)；与同组术前相比，单髁置换组的髋-膝-踝角增大(P < 0.05)，胫骨后倾角减小(P < 0.05)，髌骨高度值增大，但差异无显著性意义(P > 0.05)；④总体髋-膝-踝角由术前(-5.68±3.48)°增大至术后(0.69±0.69)°；两组间术前髋-膝-踝角、胫骨后倾角、髌骨高度值相比，差异均无显著性意义(P > 0.05)；两组间术后髋-膝-踝角、胫骨后倾角、髌骨高度值及Δ髋-膝-踝角(术后-术前)、Δ胫骨后倾角(术后-术前)、Δ髌骨高度(术后-术前)相比，差异均有显著性意义(P < 0.05)；⑤提示胫骨高位截骨和单髁置换患者在末次随访时均获得满意的效果，但术后1个月的膝关节功能评分方面，单髁置换组表现更优；相比之下，胫骨高位截骨容易出现术后髌骨低位以及胫骨后倾角增大；单髁置换术后髌骨高度未见明显改变，但胫骨后倾角出现明显的减小。
https://orcid.org/0000-0002-3482-1742 (林晓东) 

关键词: 膝骨关节炎, 胫骨高位截骨, 单髁置换, 胫骨后倾角, 髌骨高度

Abstract: BACKGROUND: Although high tibial osteotomy and unicompartmental knee arthroplasty are often used to treat unicompartmental knee osteoarthritis with varus deformity, whether there are differences in knee function at different postoperative periods and whether there are changes in knee parameters on preoperative and postoperative imaging still need further clinical study.  
OBJECTIVE: To compare the early clinical efficacy and the differences in knee imaging-related parameters of unicompartmental knee arthroplasty and open-wedge high tibial osteotomy in the treatment of unicompartmental knee osteoarthritis with varus deformity.
METHODS:  The medical record data of 126 patients with unicompartmental knee osteoarthritis with varus deformity were retrospectively analyzed, including 60 patients undergoing open-wedge high tibial osteotomy and 66 patients undergoing unicompartmental knee osteoarthritis with varus deformity. The Hospital for Special Surgery knee score was used to assess knee function preoperatively, 1 month postoperatively and the late follow-up between the two groups. Long-leg full-weight-bearing radiograph and anteroposterior and lateral radiograph of knee were taken before and after operation. The postoperative hip-knee-ankle angle, tibial posterior slope and patellar height were measured. The differences in the relevant imaging parameters of knee joint were compared between the two groups before and after operation.  
RESULTS AND CONCLUSION: (1) A total of 53 knees with high tibial osteotomy and 61 knees with unicompartmental knee arthroplasty were included in this study. The overall follow-up time was (26.29±3.84) months. (2) The Hospital for Special Surgery scores were higher in the unicompartmental knee arthroplasty group than those in the high tibial osteotomy group (P < 0.05). At the last follow-up, there was no significant difference in Hospital for Special Surgery scores between the two groups (P > 0.05). (3) Compared with preoperative data in the same group, the hip-knee-ankle angle and tibial posterior slope increased (P < 0.05), but patellar height decreased (P < 0.05) in the high tibial osteotomy group. Compared with preoperative data in the same group, hip-knee-ankle angle increased (P < 0.05), but tibial posterior slope decreased (P < 0.05), patellar height increased in the unicompartmental knee arthroplasty group, but the difference was not significantly different (P > 0.05). (4) Total hip-knee-ankle angle increased from (-5.68±3.48)° preoperatively to (0.69±0.69)° postoperatively. No significant difference was detected in hip-knee-ankle angle, tibial posterior slope and patellar height between the two groups before operation (P > 0.05). Significant differences were found in hip-knee-ankle angle, tibial posterior slope, patellar height, Δ hip-knee-ankle angle (postoperation-preoperation), Δ tibial posterior slope (postoperation-preoperation) and Δ patellar height (postoperation-preoperation) between the two groups after operation (P < 0.05). (5) It is concluded that the two groups of patients obtained satisfactory results in the late follow-up. However, the patients in the unicompartmental knee arthroplasty group had better knee function scores 1 month after surgery compared with the high tibial osteotomy group. In contrast, the high tibial osteotomy group was prone to postoperative patellar baja and increased posterior tibial slope. In the unicompartmental knee arthroplasty group, the patellar height did not change significantly after surgery, but the posterior tibial slope showed a significant decrease.

Key words: knee osteoarthritis, high tibial osteotomy, unicompartmental knee arthroplasty, tibial posterior slope, patellar height

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