Arch Orthop Trauma Surg:单室与全膝关节置换术在胫骨高位截骨失败患者中的比较

2022-08-25 医路坦克 MedSci原创

在年轻患者中膝关节内侧骨关节炎(OA)的治疗方案包括胫骨高位截骨术(HTO)和单侧膝关节置换术(UKR),研究的目的是比较UKR和TKR对以前有过失败的开放楔形HTO的膝关节的临床、放射学和功能结果。

在年轻患者中,膝关节内侧骨关节炎(OA)的外科治疗是一个有争议的问题。治疗方案包括胫骨高位截骨术(HTO)单侧膝关节置换术(UKR)高位截骨术一直被认为是有效和可靠的,尤其是在存在严重内翻畸形的情况下和年龄<60岁的患者,以及与过去相比越来越受欢迎的单侧膝关节置换(UKR)

有时UKRHTO的适应症在40岁到50岁之间的患者中重叠,他们的下肢机械轴在5°到15°之间。因此,随着UKR的广泛使用,HTO已将其适应症限制在非常年轻的患者。

根据文献,UKR在术后恢复、疼痛缓解、恢复日常活动和运动以及手术存活率方面表现出优于HTO的结果。此外,对于HTO恢复正确肢体对齐的能力还没有达成共识,因为欠矫正和过度矫正经常被报道,程序性关节退变导致失败。

目前,很少有研究调查既往HTOUKR的临床结果和生存的影响,这方面的经验仍然有限。事实上,HTO后进行部分膝关节置换一直被认为是一项要求很高的手术,因为软组织瘢痕形成、胫骨斜度改变、膝盖骨高度改变以及胫骨骨质质量差。为了克服这些问题,许多外科医生更喜欢在HTO后进行全膝关节置换术(TKR)。然而,残留内翻的存在,有时是由于HTO失败导致的,可以确定内侧膝OA的外侧间隔完整:这种设置允许为患者实施UKR,具有许多优点:快速恢复,减少出血,疼痛和软组织损伤,维持本体感觉和自然膝关节的生物力学,具有更高的重返运动的可能性。

这项回顾性研究的目的是比较UKRTKR对以前有过失败的开放楔形HTO的膝关节的临床、放射学和功能结果。

方法:对2001~2017年间施行的26例HTO术后UKR(A组)和33例HTO术后TKR(B组)进行了回顾分析,A组平均随访7.8年(2~13a),B组平均随访11.2年(4~16a)。评估包括膝关节协会评分(KSS)、加州大学洛杉矶分校活动评分(UCLA)以及安大略省西部和麦克马斯特大学骨关节炎指数(WOMAC)。在手术前和术后进行标准的膝关节X光片和长期X光片,以评估假体存活率、冠状排列和髌骨高度。

结果:两组患者术后KSS、UCLA和WOMAC评分均较术前有明显改善(p<0.001)。两组的临床和术后功能评分无统计学差异(p=N.S.)。在后续行动中。B组平均机械轴角为0.50°,A组为2.70°,差异有统计学意义(P<0.001)。

表1 患者人口统计和人体测量数据

表2 术前和随访状态的比较

表3 两组术后结果比较

表4 影像学评估结果:术前和随访状态的比较

表5 两组影像学结果的比较

结论:既往HTO失败后行UKR是一种安全有效的方法,其临床、放射学和功能结果与HTOTKR相当。

文献来源:Parente A,  Legnani C,  Bargagliotti M,Unicompartmental vs. total knee replacement in patients with failed high tibial osteotomy.Arch Orthop Trauma Surg 2022 Aug;142(8)

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    2023-03-03 bsmagic9140
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    2023-01-09 siiner
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encodeId=5b831548428df, content=<a href='/topic/show?id=39bf2964295' target=_blank style='color:#2F92EE;'>#全膝关节置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29642, encryptionId=39bf2964295, topicName=全膝关节置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2e4014073525, createdName=12498f6em11暂无昵称, createdTime=Tue Aug 23 14:34:16 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576851, encodeId=8eb015e685134, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=054816326830, createdName=ms117281293605716, createdTime=Tue Aug 23 14:34:16 CST 2022, time=2022-08-23, status=1, ipAttribution=)]
    2022-12-09 yxch48
  5. [GetPortalCommentsPageByObjectIdResponse(id=1657673, encodeId=c56b165e673d2, content=<a href='/topic/show?id=3ca31e71903' target=_blank style='color:#2F92EE;'>#TRA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17719, encryptionId=3ca31e71903, topicName=TRA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=757b24868428, createdName=bsmagic9140, createdTime=Fri Mar 03 03:34:16 CST 2023, time=2023-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1754250, encodeId=02621e54250bc, 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=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30135, encryptionId=7d3330135ac, topicName=关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, 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encodeId=5b831548428df, content=<a href='/topic/show?id=39bf2964295' target=_blank style='color:#2F92EE;'>#全膝关节置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29642, encryptionId=39bf2964295, topicName=全膝关节置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2e4014073525, createdName=12498f6em11暂无昵称, createdTime=Tue Aug 23 14:34:16 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576851, encodeId=8eb015e685134, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=054816326830, createdName=ms117281293605716, createdTime=Tue Aug 23 14:34:16 CST 2022, time=2022-08-23, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1657673, encodeId=c56b165e673d2, content=<a href='/topic/show?id=3ca31e71903' target=_blank style='color:#2F92EE;'>#TRA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17719, encryptionId=3ca31e71903, topicName=TRA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=757b24868428, createdName=bsmagic9140, createdTime=Fri Mar 03 03:34:16 CST 2023, time=2023-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1754250, encodeId=02621e54250bc, 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=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30135, encryptionId=7d3330135ac, topicName=关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=44, 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=Tue Aug 23 14:34:16 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1412191, encodeId=57ee141219150, content=<a href='/topic/show?id=504a83820a0' target=_blank style='color:#2F92EE;'>#胫骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83820, encryptionId=504a83820a0, topicName=胫骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5c442828835, createdName=yb6561, createdTime=Tue Aug 23 14:34:16 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1548428, 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createdTime=Tue Aug 23 14:34:16 CST 2022, time=2022-08-23, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1657673, encodeId=c56b165e673d2, content=<a href='/topic/show?id=3ca31e71903' target=_blank style='color:#2F92EE;'>#TRA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17719, encryptionId=3ca31e71903, topicName=TRA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=757b24868428, createdName=bsmagic9140, createdTime=Fri Mar 03 03:34:16 CST 2023, time=2023-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1754250, encodeId=02621e54250bc, 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=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30135, encryptionId=7d3330135ac, topicName=关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=44, 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=Tue Aug 23 14:34:16 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1412191, encodeId=57ee141219150, content=<a href='/topic/show?id=504a83820a0' target=_blank style='color:#2F92EE;'>#胫骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83820, encryptionId=504a83820a0, topicName=胫骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5c442828835, createdName=yb6561, createdTime=Tue Aug 23 14:34:16 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1548428, encodeId=5b831548428df, content=<a href='/topic/show?id=39bf2964295' target=_blank style='color:#2F92EE;'>#全膝关节置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29642, encryptionId=39bf2964295, topicName=全膝关节置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2e4014073525, createdName=12498f6em11暂无昵称, createdTime=Tue Aug 23 14:34:16 CST 2022, time=2022-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576851, encodeId=8eb015e685134, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=054816326830, createdName=ms117281293605716, createdTime=Tue Aug 23 14:34:16 CST 2022, time=2022-08-23, status=1, ipAttribution=)]
    2022-08-23 yb6561
  8. 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  9. 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