中国修复重建外科杂志

中国修复重建外科杂志

单髁关节置换治疗膝关节自发性骨坏死的疗效分析

查看全文

目的探讨单髁关节置换治疗膝关节自发性骨坏死(spontaneous osteonecrosis of the knee,SONK)的临床疗效。 方法回顾分析 2012 年 1 月—2016 年 12 月,经病理检查确诊为 SONK 且采用牛津第 3 代单髁膝关节假体置换治疗的 31 例患者临床资料。男 5 例,女 26 例;年龄 48~79 岁,平均 64.3 岁。左膝 16 例,右膝 15 例。病程 6~26 个月,平均 14.7 个月。术前膝关节疼痛视觉模拟评分(VAS)为(6.00±1.15)分,美国特种外科医院(HSS)评分为(55.77±11.03)分,膝关节活动度(range of motion,ROM)为(114.68±10.40)°。影像学检查示病变局限于膝关节内侧间室,Aglietti 分期:Ⅳ期 19 例、Ⅴ 期 12 例。膝关节胫股角(femorotibial angle,FTA)为(177.39±1.63)°、胫骨后倾角(posterior tibial slope,PTS)为(84.05±1.39)°。 结果术后切口均Ⅰ期愈合。患者均获随访,随访时间 14~46 个月,平均 25 个月。末次随访时 VAS 评分为(2.06±0.72)分,HSS 评分为(86.45±3.67)分,均较术前显著改善(t=22.73,P=0.00;t=–14.72,P=0.00);ROM 为(118.06±3.80)°,与术前比较差异无统计学意义(t=–1.78,P=0.08)。X 线片复查示随访期间无假体周围感染及假体松动、脱位等并发症发生。末次随访时测量 FTA 为(177.51±1.98)°,与术前比较差异无统计学意义(t=–0.38,P=0.71);而 PTS 为(85.30±1.19)°,与术前比较差异有统计学意义(t=–4.07,P=0.00)。 结论单髁关节置换术治疗 SONK 具有手术创伤小、骨量保留多、术后恢复快等优点,可获得较好的早中期疗效。

ObjectiveTo analyse the effectiveness of unicompartmental knee arthroplasty (UKA) for the patients with spontaneous osteonecrosis of the knee (SONK). MethodsBetween January 2012 and December 2016, 31 patients with SONK was admitted and treated with medial UKA. All patients were examined by both plain radiography and magnetic resonance images. The patients were composed of 5 men and 26 women with an average age of 64.3 years (range, 48-79 years), and with 16 left joints and 15 right joints. The average disease duration was 14.7 months (range, 6-26 months). Preoperative visual analogue scale (VAS) was 6.00±1.15, Hospital for Special Surgery (HSS) score was 55.77±11.03, and knee range of motion (ROM) was (114.68±10.40)°. The imaging examinations showed that all the lesions were located in the medial compartment of the knee joint and there were 19 patients with Aglietti stage Ⅳ and 12 patients with Aglietti stage Ⅴ. Preoperative femorotibial angle (FTA) was (177.39±1.63)° and posterior tibial slope (PTS) was (84.05±1.39)°. ResultsAll the incisions healed by first intention. All patients were followed up 14-46 months (mean, 25 months). At last follow-up, VAS score was 2.06±0.72 and HSS score was 86.45±3.67, which both improved significantly when compared with preoperative scores (t=22.73, P=0.00; t=–14.72, P=0.00). ROM was (118.06±3.80)° with no significant difference when compared with preoperative ROM (t=–1.78, P=0.08). The X-ray films showed there was no severe adverse events, such as periprosthetic infection, aseptic loosening, bearing dislocation, and so on. At last follow- up, PTS was (85.30±1.19)° with significant difference compared with preoperative one (t=–4.07, P=0.00); while FTA was (177.51±1.98)° with no significant difference when compared with preoperative FTA (t=–0.38, P=0.71). ConclusionUKA may be an optional management for SONK with minimally invasive, bone-preserving, and rapid recovery.

关键词: 膝关节自发性骨坏死; 前内侧骨关节炎; 单髁关节置换

Key words: Spontaneous osteonecrosis of the knee; anteromedial osteoarthritis; unicompartmental knee arthroplasty

引用本文: 胡德庆, 黄子达, 张文明, 林建华, 李文波. 单髁关节置换治疗膝关节自发性骨坏死的疗效分析. 中国修复重建外科杂志, 2019, 33(1): 13-17. doi: 10.7507/1002-1892.201805127 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Marcacci M, Andriolo L, Kon E, et al. Aetiology and pathogenesis of bone marrow lesions and osteonecrosis of the knee. EFORT Open Rev, 2017, 1(5): 219-224.
2. Karim AR, Cherian JJ, Jauregui JJ, et al. Osteonecrosis of the knee: review. Ann Transl Med, 2015, 3(6): 1-11.
3. Akamatsu Y, Mitsugi N, Hayashi T, et al. Low bone mineral density is associated with the onset of spontaneous osteonecrosis of the knee. Acta Orthop, 2012, 83(3): 249-255.
4. Jordan RW, Aparajit P, Docker C, et al. The importance of early diagnosis in spontaneous osteonecrosis of the knee-A case series with six-year follow-up. Knee, 2016, 23(4): 702-707.
5. Plett SK, Hackney LA, Heilmeier U, et al. Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome. Skeletal Radiol, 2015, 44(12): 1785-1794.
6. Juréus J, Lindstrand A, Geijer M, et al. The natural course of spontaneous osteonecrosis of the knee (SPONK): a 1- to 27-year follow-up of 40 patients. Acta Orthop, 2013, 84(4): 410-414.
7. Wilmot AS, Ruutiainen AT, Bakhru PT, et al. Subchondral insufficiency fracture of the knee: A recognizable associated soft tissue edema pattern and a similar distribution among men and women. Eur J Radiol, 2016, 85(11): 2096-2103.
8. Ohdera T, Miyagi S, Tokunaga M, et al. Spontaneous osteonecrosis of the lateral femoral condyle of the knee: a report of 11 cases. Arch Orthop Trauma Surg, 2008, 128(8): 825-831.
9. Yang WM, Zhao CQ, Lu ZY, et al. Clinical characteristics and treatment of spontaneous osteonecrosis of medial tibial plateau: A retrospective case study. Chin Med J (Engl), 2018, 131(21): 2544-2550.
10. Gorbachova T, Melenevsky Y, Cohen M, et al. Osteochondral lesions of the knee: Differentiating the most common entities at MRI. Radiographics, 2018, 38(5): 1478-1495.
11. Nakayama H, Iseki T, Kanto R, et al. Analysis of risk factors for poor prognosis in conservatively managed early-stage spontaneous osteonecrosis of the knee. Knee, 2016, 23(1): 25-28.
12. Hatanaka H, Yamamoto T, Motomura G, et al. Histopathologic findings of spontaneous osteonecrosis of the knee at an early stage: a case report. Skeletal Radiol, 2016, 45(5): 713-716.
13. Mears SC, McCarthy EF, Jones LC, et al. Characterization and pathological characteristics of spontaneous osteonecrosis of the knee. Iowa Orthop J, 2009, 29: 38-42.
14. Aglietti P, Insall JN, Buzzi R, et al. Idiopathic osteonecrosis of the knee. Aetiology, prognosis and treatment. J Bone Joint Surg (Br), 1983, 65(5): 588-597.
15. Di Caprio F, Meringolo R, Navarra MA, et al. Postarthroscopy osteonecrosis of the knee: Current concepts. Joints, 2017, 5(4): 229-236.
16. Mont MA, Baumgarten KM, Rifai A, et al. Atraumatic osteonecrosis of the knee. J Bone Joint Surg (Am), 2000, 82(9): 1279-1290.
17. Jacobs CA, Berend KR, Lombardi AV Jr, et al. The location and severity of preoperative subchondral bone marrow lesions were not associated with inferior postoperative outcomes after medial unicompartmental knee arthroplasty or total knee arthroplasty. J Arthroplasty, 2016, 31(11): 2476-2480.
18. Berend KR, Lombardi AV Jr, Jacobs CA. The combination of preoperative bone marrow lesions and partial-thickness cartilage loss did not result in inferior outcomes after medial unicompartmental knee arthroplasty. J Arthroplast, 2017, 32(10): 3000-3003.
19. Ma T, Tu Y, Xue H, et al. Unicompartmental knee arthroplasty for spontaneous osteonecrosis. J Orthop Surg (Hong Kong), 2017, 25(1): 1-5.
20. Kaneko T, Kono N, Sunakawa T, et al. Reliable patient-reported outcome measure and survivorship of UKA for primary spontaneous osteonecrosis. Eur J Orthop Surg Traumatol, 2018. [Epub ahead of print].
21. Chalmers BP, Mehrotra KG, Sierra RJ, et al. Reliable outcomes and survivorship of unicompartmental knee arthroplasty for isolated compartment osteonecrosis. Bone Joint J, 2018, 100-B(4): 450-454.
22. Jauregui JJ, Blum CL, Sardesai N, et al. Unicompartmental knee arthroplasty for spontaneous osteonecrosis of the knee: A meta-analysis. J Orthop Surg (Hong Kong), 2018, 26(2): 1-6.
23. 郭万首, 张启栋, 刘朝晖, 等. 膝关节单髁置换术治疗晚期膝关节自发性骨坏死. 中华骨科杂志, 2014, 34(6): 631-637.
24. Guo WS, Zhang QD, Liu ZH, et al. Minimally invasive unicompartmental knee arthroplasty for spontaneous osteonecrosis of the knee. Orthop Surg, 2015, 7(2): 119-124.