Knee Surg Sports Traumatol Arthrosc:非骨水泥型和骨水泥型单室膝关节置换术中假体周围胫骨骨折发生率的比较

2022-09-16 医路坦克 MedSci原创

单室膝关节置换术(UKA)是治疗单纯性间隔性膝关节炎的一种成熟的治疗方法,本研究目的是通过临床研究来评估骨水泥型和非骨水泥型UKA假体周围胫骨骨折的发生率,总结英国假体周围胫骨骨折的特点及危险因素。

单室膝关节置换术(UKA)是治疗单纯性间隔性膝关节炎的一种成熟的治疗方法。与全膝关节置换术(TKA)相比,UKA的优点包括减少发病率和死亡率,保留正常的膝关节运动学和更快的恢复。UKA翻修的原因包括无菌性松动、对齐不良、骨关节炎进展、不稳定、感染和假体周围骨折。

假体周围骨折是一种复杂的并发症,在UKA中具有严重的后果,并与死亡率和发病率的增加有关。在UKA中,假体周围骨折最常发生在胫侧(约87%)。虽然与UKA的其他并发症相比,这些假体周围胫骨骨折相对较少,但最近的研究表明,与骨水泥UKA相比,非骨水泥UKA假体周围骨折的发生率更高。由于非骨水泥固定治疗UKAS的兴趣预计将增加,假体周围骨折的发生率也可能增加。然而,研究可能不能提供关于所有骨折的可靠信息,因为一些假体周围骨折是内部固定的,而且假体没有修改或得到保守治疗。研究的另一个常见限制是胫骨和股骨假体周围骨折没有单独报道。这强调了使用临床研究对骨水泥型非骨水泥型UKA假体周围胫骨骨折发生率进行彻底评估的必要性。此外,缺乏对英国假体周围胫骨骨折的特征和危险因素的现有证据进行综述的研究,以获得更好的理解和认识。

因此,本研究的主要目的是通过临床研究来评估骨水泥型和非骨水泥型UKA假体周围胫骨骨折的发生率。其次,对相关研究进行系统综述,总结英国假体周围胫骨骨折的特点及危险因素。

方法:检索Pubmed、Cochrane和Embase数据库。包括任何描述英国假体周围胫骨骨折的比例、特征或危险因素的临床、实验室或病例报告研究。仅使用临床研究的数据进行比例荟萃分析来估计骨折的发生率。对有关特征和风险因素的信息进行了评估和总结。

单筋膜膝关节置换术后假体周围胫骨骨折类型的X线片。I-II:骨折线从胫骨切除角延伸至内侧皮质,导致大(I)或小(II)的内侧平台骨折。这些骨折线是在不同种植体设计的患者的正后位(AP)上确定的。III:胫骨内翻下沉或胫骨前部下沉,导致内侧小块骨折。这些骨折是在美联社的切面上发现的。骨折线从螺钉固定延伸至后皮质,导致后内侧平台骨折。1例非骨水泥型固定支撑型UKA加螺钉固定的患者,在AP面上无法辨认出骨折线,而只能在侧位片上辨认。V:骨折线从胫骨龙骨延伸至内侧皮质,导致内侧平台骨折。这些骨折线是在牛津部分膝关节植入物患者的美联社视图上发现的。VI:创伤事件后六年,两条骨折线从胫骨切除的拐角延伸到内侧和外侧皮质,导致双髁平台骨折。在AP切面上发现了一例侧方UKA患者的骨折线

UKAS无骨折与有骨折的疗效比较

结果:共有81项研究符合纳入标准。根据41项临床研究,非骨水泥组骨折发生率为1.24%(95%可信区间0.64~2.41),骨水泥组骨折发生率为1.58%(95%可信区间1.06~2.36)。在目前的文献中,大多数骨折发生在手术中或术后3个月内(127例中有91例,占72%),而且是非创伤性的(113例中95例,占84%)。在21张可用的X线片中观察到6种不同的骨折类型。实验室研究表明,过度干涉配合(压配合)、过度胫骨切除、后方矢状切开过深以及低骨密度(BMD)会降低发生假体周围胫骨骨折所需的力。临床研究表明,假体周围胫骨骨折与体重指数和术后对齐角度增加、高龄、骨密度降低、女性和非常突出的胫骨内侧髁有关。

结论:非骨水泥型和骨水泥型UKA假体周围胫骨骨折的发生率较低。然而,外科医生应该意识到,与非骨水泥UKA相结合的过度干涉可能会带来额外的风险,因此可能不会对手术失误和假体周围胫骨骨折风险较高的患者宽容。

文献来源:Burger JA,  Jager T,  Dooley MS,Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis.Knee Surg Sports Traumatol Arthrosc 2022 Mar;30(3)

 

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    2023-06-17 bsmagic9140
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content=<a href='/topic/show?id=7c5615628ad' target=_blank style='color:#2F92EE;'>#ROS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15628, encryptionId=7c5615628ad, topicName=ROS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370352, encodeId=3c4713e035290, content=<a href='/topic/show?id=b103101e18e7' target=_blank style='color:#2F92EE;'>#骨水泥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101718, encryptionId=b103101e18e7, topicName=骨水泥)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b952312, createdName=zhs3882, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390137, encodeId=4ff7139013e09, content=<a href='/topic/show?id=c4d0858e23b' target=_blank style='color:#2F92EE;'>#膝关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85872, encryptionId=c4d0858e23b, topicName=膝关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a0802500050, createdName=肉我只吃一口, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=)]
    2023-05-28 siiner
  4. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390137, encodeId=4ff7139013e09, content=<a href='/topic/show?id=c4d0858e23b' target=_blank style='color:#2F92EE;'>#膝关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85872, encryptionId=c4d0858e23b, topicName=膝关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a0802500050, createdName=肉我只吃一口, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1754252, encodeId=87491e54252e4, content=<a href='/topic/show?id=7d3330135ac' target=_blank style='color:#2F92EE;'>#关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30135, encryptionId=7d3330135ac, topicName=关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=050736663344, createdName=apoenzyme, createdTime=Sat Jul 22 23:09:56 CST 2023, time=2023-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1657685, encodeId=f0ef165e6855a, content=<a href='/topic/show?id=3ca31e71903' target=_blank style='color:#2F92EE;'>#TRA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17719, encryptionId=3ca31e71903, topicName=TRA)], attachment=null, authenticateStatus=null, createdAvatar=null, 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  6. 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content=<a href='/topic/show?id=7c5615628ad' target=_blank style='color:#2F92EE;'>#ROS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15628, encryptionId=7c5615628ad, topicName=ROS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370352, encodeId=3c4713e035290, content=<a href='/topic/show?id=b103101e18e7' target=_blank style='color:#2F92EE;'>#骨水泥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101718, encryptionId=b103101e18e7, topicName=骨水泥)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b952312, createdName=zhs3882, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390137, encodeId=4ff7139013e09, content=<a href='/topic/show?id=c4d0858e23b' target=_blank style='color:#2F92EE;'>#膝关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85872, encryptionId=c4d0858e23b, topicName=膝关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a0802500050, createdName=肉我只吃一口, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=)]
    2023-06-10 yxch48
  7. [GetPortalCommentsPageByObjectIdResponse(id=1754252, encodeId=87491e54252e4, content=<a href='/topic/show?id=7d3330135ac' target=_blank style='color:#2F92EE;'>#关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30135, encryptionId=7d3330135ac, topicName=关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=050736663344, createdName=apoenzyme, createdTime=Sat Jul 22 23:09:56 CST 2023, time=2023-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1657685, encodeId=f0ef165e6855a, content=<a href='/topic/show?id=3ca31e71903' target=_blank style='color:#2F92EE;'>#TRA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17719, encryptionId=3ca31e71903, topicName=TRA)], attachment=null, authenticateStatus=null, createdAvatar=null, 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objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Sat Jun 10 18:09:56 CST 2023, time=2023-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357982, encodeId=04c3135e9824e, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1364826, encodeId=a4f813648266d, content=<a href='/topic/show?id=7c5615628ad' target=_blank style='color:#2F92EE;'>#ROS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15628, encryptionId=7c5615628ad, topicName=ROS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370352, encodeId=3c4713e035290, content=<a href='/topic/show?id=b103101e18e7' target=_blank style='color:#2F92EE;'>#骨水泥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101718, encryptionId=b103101e18e7, topicName=骨水泥)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b952312, createdName=zhs3882, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390137, encodeId=4ff7139013e09, content=<a href='/topic/show?id=c4d0858e23b' target=_blank style='color:#2F92EE;'>#膝关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85872, encryptionId=c4d0858e23b, topicName=膝关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a0802500050, createdName=肉我只吃一口, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=)]
    2022-09-17 zhaojie88
  8. [GetPortalCommentsPageByObjectIdResponse(id=1754252, encodeId=87491e54252e4, content=<a href='/topic/show?id=7d3330135ac' target=_blank style='color:#2F92EE;'>#关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30135, encryptionId=7d3330135ac, topicName=关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=050736663344, createdName=apoenzyme, createdTime=Sat Jul 22 23:09:56 CST 2023, time=2023-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1657685, encodeId=f0ef165e6855a, content=<a href='/topic/show?id=3ca31e71903' target=_blank style='color:#2F92EE;'>#TRA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17719, encryptionId=3ca31e71903, topicName=TRA)], attachment=null, authenticateStatus=null, createdAvatar=null, 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390137, encodeId=4ff7139013e09, content=<a href='/topic/show?id=c4d0858e23b' target=_blank style='color:#2F92EE;'>#膝关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85872, encryptionId=c4d0858e23b, topicName=膝关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a0802500050, createdName=肉我只吃一口, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=)]
    2022-09-17 一叶知秋
  9. 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content=<a href='/topic/show?id=7c5615628ad' target=_blank style='color:#2F92EE;'>#ROS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15628, encryptionId=7c5615628ad, topicName=ROS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370352, encodeId=3c4713e035290, content=<a href='/topic/show?id=b103101e18e7' target=_blank style='color:#2F92EE;'>#骨水泥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101718, encryptionId=b103101e18e7, topicName=骨水泥)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b952312, createdName=zhs3882, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390137, encodeId=4ff7139013e09, content=<a href='/topic/show?id=c4d0858e23b' target=_blank style='color:#2F92EE;'>#膝关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85872, encryptionId=c4d0858e23b, topicName=膝关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a0802500050, createdName=肉我只吃一口, createdTime=Sat Sep 17 12:09:56 CST 2022, time=2022-09-17, status=1, ipAttribution=)]
    2022-09-17 zhs3882
  10. 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