中华骨科杂志2024,Vol.44Issue(5) :279-286.DOI:10.3760/cma.j.cn121113-20230530-00309

牛津单髁膝关节置换术后矢状面垫片运动与胫骨后倾角的关系

Relationship between the Oxford unicompartmental knee arthroplasty sagittal bearing movement extent and posterior tibial slope

呼啸 李亮亮 张民
中华骨科杂志2024,Vol.44Issue(5) :279-286.DOI:10.3760/cma.j.cn121113-20230530-00309

牛津单髁膝关节置换术后矢状面垫片运动与胫骨后倾角的关系

Relationship between the Oxford unicompartmental knee arthroplasty sagittal bearing movement extent and posterior tibial slope

呼啸 1李亮亮 2张民2
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作者信息

  • 1. 山西医科大学第二临床医学院,太原 030001
  • 2. 山西医科大学第二医院关节与运动医学科,太原 030000
  • 折叠

摘要

目的 分析牛津单髁膝关节置换(unicompartmental knee arthroplasty,UKA)术后矢状面垫片运动与胫骨后倾角的相关性及其对临床疗效的影响.方法 回顾性分析2022年1至3月于山西医科大学第二医院关节与运动医学科接受牛津第三代UKA治疗的前内侧膝关节骨关节炎患者29例(30膝),男7例(8膝)、女22例(22膝),年龄(63.3±7.9)岁(范围47~84岁).根据术后屈膝135°时膝关节侧位X线片垫片是否出现后悬出分为后悬出组(9膝)和未悬出组(21膝).比较两组术前及术后6个月牛津膝关节评分(Oxford knee score,OKS)、胫骨后倾角及垫片的影像学结果.采用Pearson相关性分析衡量术后矢状面垫片运动与OKS和胫骨后倾角的关系.结果 所有患者均顺利完成手术并获得随访,随访时间为(7.2±1.1)个月(范围6~9个月).30%(9/30)的垫片出现后悬出.后悬出组屈膝135°时垫片位置为83.33%±3.46%,后悬出距离为(1.12±1.80)mm,大于未悬出组的73.24%±3.40%和(-4.45±2.37)mm,差异有统计学意义(P<0.05).后悬出组垫片运动范围为33.22%±8.51%,大于未悬出组的23.36%±9.32%,差异有统计学意义(P<0.05).后悬出组术后6个月胫骨后倾角为2.68°±2.20°,小于未悬出组的4.59°±2.69°,差异有统计学意义(P<0.05).后悬出组术后6个月OKS为(19.00±8.84)分,未悬出组为(19.14±7.00)分,差异无统计学意义(P>0.05).Pearson相关性分析结果显示屈膝135°时垫片后悬出距离与垫片位置呈正相关(r=0.97,P<0.001),与术后胫骨后倾角大小呈负相关(r=-0.38,P=0.041),与手术前后胫骨后倾角变化量呈负相关(r=-0.37,P=0.045),与垫片运动范围呈正相关(r=0.68,P<0.001),与屈膝0°时垫片位置无相关性(r=-0.15,P=0.423).而垫片运动范围与屈膝0°时垫片位置呈负相关(r=-0.82,P<0.001),与屈膝135°时垫片位置呈正相关(r=0.70,P<0.001),与术后胫骨后倾角大小呈负相关(r=-0.48,P=0.007),与手术前后胫骨后倾角的变化量呈负相关(r=-0.39,P<0.001),与屈膝135°时垫片悬出距离呈正相关(r=0.68,P=0.033).结论 牛津UKA术后垫片后悬出的发生率为30%,垫片后悬出、垫片运动范围增大与术后胫骨后倾角减小有关.虽然未发现垫片悬出对膝关节功能的影响,但术中应调整胫骨后倾角以降低垫片后悬出的发生率.

Abstract

Objective To analyze the correlation between sagittal bearing movement and posterior tibial slope after Ox-ford unicompartmental knee arthroplasty(UKA)and its effect on clinical results.Methods A total of 29 patients(30 knees)with anterior medial knee osteoarthritis who underwent Oxford third-generation UKA in the Department of Joint and Sports Medicine of the Second Hospital of Shanxi Medical University from January 2022 to March 2022 were retrospectively analyzed,including 7 males(8 knees)and 22 females(22 knees),aged 63.3±7.9 years(range,47-84 years).The patients were divided into overhang group(9 knees)and non-overhang group(21 knees)according to whether there was overhang of the bearing in the sagittal X-ray film at 135° flexion after operation.The preoperative and postoperative Oxford Knee Score(OKS),tibial posterior slope angle and radiographic results of the bearing were compared between the two groups.Pearson correlation analysis was used to measure the re-lationship between postoperative sagittal bearing movement and OKS and tibial posterior slope.Results All patients successfully completed the operation and were followed up for 7.2±1.1 months(range,6-9 months).30%(9/30)of the bearing were overhung.When the knee flexion was 135°,the position of the bearing in the overhang group was 83.33%±3.46%,and the posterior suspen-sion distance was 1.12±1.80 mm,which was significantly higher than those in the non-overhang group(73.24%±3.40%and-4.45± 2.37 mm,P<0.05).The bearing movement distance in the overhang group was 33.22%±8.51%,which was larger than that in the non-overhang group(23.36%±9.32%),and the difference was statistically significant(P<0.05).The posterior tibial slope of the overhang group was 2.68°±2.20° at 6 months after operation,which was smaller than that of the non-overhang group(4.59°±2.69°),and the difference was statistically significant(P<0.05).The OKS score was 19.00±8.84 in the overhang group and 19.14±7.00 in the non-overhang group at 6 months after operation,and the difference was not statistically significant(P>0.05).Pearson correla-tion analysis showed that the overhang distance of the bearing was positively correlated with the bearing position at 135° knee flex-ion(r=0.97,P<0.001),and negatively correlated with the posterior tibial slope(r=-0.38,P=0.041).It was negatively correlated with the change of posterior tibial slope(r=-0.37,P=0.045),positively correlated with the bearing movement distance(r=0.68,P<0.001),and had no correlation with the position of the bearing at 0° knee flexion(r=-0.15,P=0.423).The bearing movement dis-tance was negatively correlated with the position of the bearing at 0° of knee flexion(r=-0.82,P<0.001),positively correlated with the position of the bearing at 135° of knee flexion(r=0.70,P<0.001),and negatively correlated with the posterior tibial slope(r=-0.48,P=0.007).It was negatively correlated with the change of posterior tibial slope(r=-0.39,P<0.001),and positively correlated with the overhang distance of bearing at 135° knee flexion(r=0.68,P=0.033).Conclusion The incidence of bearing overhang at Oxford UKA is 30%.The bearing overhang and the increase of the bearing movement distance are related to the de-crease of the posterior tibial slope after the operation.Although no effect of bearing overhang on knee joint function was found,the posterior tibial slope should be adjusted during the operation to reduce the incidence of bearing overhang.

关键词

骨关节炎,膝/关节成形术,置换,膝/脱位/治疗结果

Key words

Osteoarthritis,knee/Arthroplasty,replacement,knee/Dislocations/Treatment outcome

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基金项目

山西省留学回国人员科技活动择优资助项目(20210008)

出版年

2024
中华骨科杂志
中华医学会

中华骨科杂志

CSTPCDCSCD北大核心
影响因子:2.137
ISSN:0253-2352
参考文献量40
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