牛津人工单髁关节置换假体生存分析及并发症处理策略
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摘要
目的通过分析牛津3期活动平台人工单髁关节置换假体生存率,探讨其中长期临床疗效以及相关并发症的处理原则和预防策略。方法选择自2007年4月至2016年10月期间,济南军区总医院骨病科应用人工单髁关节置换手术患者共435例515膝,均系膝关节前内侧骨关节病,其中男150例,女285例;年龄45~83岁,平均(61±8)岁。身体质量指数19~36 kg/m2,平均(24±3) kg/m2。记录手术前后膝关节活动度(ROM)变化,采用美国膝关节协会评分(KSS评分)与牛津大学膝关节评分(OKS评分)评估临床疗效,记录术后所有并发症发生情况;采用Kaplan-Meier生存分析方法评估患者的假体生存率,对术前及末次随访的ROM变化、KSS评分、OKS评分分别进行配对t检验,以P <0. 05为差异有统计学意义。结果 435例515膝全部完成随访,平均(5. 2±1. 8)年。至末次随访时,KSS评分由术前平均(59±10),改善至术后平均(93±8)(t=-2. 586,P <0. 05); OKS评分由术前平均(24±8),提高至术后平均(43±5)(t=-2. 056,P <0. 05);膝关节术前平均(111±5)°,术后ROM平均(127±8)°(t=-2. 334,P <0. 05)。所有患者人工单髁关节假体总生存率为92. 2%。515膝单髁关节中共有15例(2. 9%)并发症发生,其中聚乙烯活动半月板衬垫脱位6例(1. 2%);迟发性深部感染1例(0. 2%),经规范抗感染治疗无效后行二期全膝关节翻修术,术后正常恢复; 3例出现股骨髁侧假体松动(0. 6%,含1例同时衬垫脱位病例),其中2例进行单髁关节翻修,1例予以全膝关节翻修; 2例患者出现关节囊反复无菌性积液(0. 4%),予以关节抽液并物理治疗后恢复; 2例术后出现关节内游离体(0. 4%),行关节镜手术取出后绞索症状消失; 1例术后膝关节不明原因疼痛(0. 2%),保守治疗后恢复; 1例术中前交叉韧带止点部分撕脱(0. 2%),术中予以韧带线缝合固定,术后铰链支具固定41周后功能锻炼,膝关节功能恢复良好。结论牛津3期活动平台人工单髁关节置换是治疗膝内侧骨关节病的最佳治疗方法,临床疗效可靠,相关并发症发生率低;正确的适应证选择及成熟的外科操作能够保证UKA获得良好效果,降低并发症发生率;并发症的治疗需仔细分析发生的原因和类型,给予适当的处理。
Objective To analyze the long-term survival rate of Oxford medial unicompartmental knee arthroplasty,and to investigate the management and prevention strategy for complications. Methods A retrospective analysis was performed on 435 patients(515 knees) with anteromedial osteoarthritis of knee treated by Oxford unicompartmental knee arthroplasty in the Department of Orthopedic,the General Hospital of Jinan Military Commanding Region,from April 2007 to October 2016. There were 150 males and 285 females, whose mean age was(61 ± 8) years. The mean body mass index(BMI) was(24 ± 3) kg/m2,range: 19 ~ 36 kg/m2. The knee range of movement(ROM),Knee Society score(KSS) and Oxford knee score(OKS) were used to evaluate the clinical efficacy. All the postoperative complications were recorded,and Kaplan-Meier survival analysis was used to evaluate the survival rate of the prosthesis. The ROM,KSS score and OKS score were analysized by paired t test. Results The average follow-up time was(5. 2 ± 1. 8)years. The preoperative KSS score was(59 ± 10),and the postoperative KSS score was(93 ± 8)(t =-2. 586,P < 0. 05). The preoperative OKS score was(24 ± 8),and the postoperative OKS score was(43 ±5)(t =-2. 056,P < 0. 05). The preoperative ROM of knee was(111 ± 5) °,and the postoperative ROM of knee was(127 ± 8) °(t =-2. 334,P < 0. 05). The total survival rate of the prosthesis was 92. 2%. There were 15 cases with complications(2. 9%) : six cases of polyethylene insert dislocation(1. 2%); one case of delayed deep infections(0. 2%),treated with revision of total knee arthroplasty; three cases of femoral condyle prosthesis loosening(0. 6%),including one case of dislocation at the same time,of which two cases were treated with revision of unicompartmental arthroplasty and one case was treated with revision of total knee arthroplasty; two cases of recurrent aseptic joint effusion(0. 4%), treated with joint drainage and physiotherapy; two cases of intra-articular free bodies(0. 4%),treated with arthroscopic surgery; one case of unexplained pain,recovered after conservative treatment; one case of intraoperative injury of anterior cruciate ligament(0. 2%),treated with ligament suture during operation and the hinge brace was fixed for four weeks,and the function of the knee joint recovered. Conclusions Oxford medial unicompartmental knee arthroplasty is the best treatment for antero-medial osteoarthritis of knee,of which the clinical efficacy is reliable,and the incidence of complications is low. Mature surgical procedures can ensure good results of UKA and reduce the incidence of complications. The causes and types of complications should be carefully analyzed and appropriate treatment should be given.
Objective To analyze the long-term survival rate of Oxford medial unicompartmental knee arthroplasty,and to investigate the management and prevention strategy for complications. Methods A retrospective analysis was performed on 435 patients(515 knees) with anteromedial osteoarthritis of knee treated by Oxford unicompartmental knee arthroplasty in the Department of Orthopedic,the General Hospital of Jinan Military Commanding Region,from April 2007 to October 2016. There were 150 males and 285 females, whose mean age was(61 ± 8) years. The mean body mass index(BMI) was(24 ± 3) kg/m2,range: 19 ~ 36 kg/m2. The knee range of movement(ROM),Knee Society score(KSS) and Oxford knee score(OKS) were used to evaluate the clinical efficacy. All the postoperative complications were recorded,and Kaplan-Meier survival analysis was used to evaluate the survival rate of the prosthesis. The ROM,KSS score and OKS score were analysized by paired t test. Results The average follow-up time was(5. 2 ± 1. 8)years. The preoperative KSS score was(59 ± 10),and the postoperative KSS score was(93 ± 8)(t =-2. 586,P < 0. 05). The preoperative OKS score was(24 ± 8),and the postoperative OKS score was(43 ±5)(t =-2. 056,P < 0. 05). The preoperative ROM of knee was(111 ± 5) °,and the postoperative ROM of knee was(127 ± 8) °(t =-2. 334,P < 0. 05). The total survival rate of the prosthesis was 92. 2%. There were 15 cases with complications(2. 9%) : six cases of polyethylene insert dislocation(1. 2%); one case of delayed deep infections(0. 2%),treated with revision of total knee arthroplasty; three cases of femoral condyle prosthesis loosening(0. 6%),including one case of dislocation at the same time,of which two cases were treated with revision of unicompartmental arthroplasty and one case was treated with revision of total knee arthroplasty; two cases of recurrent aseptic joint effusion(0. 4%), treated with joint drainage and physiotherapy; two cases of intra-articular free bodies(0. 4%),treated with arthroscopic surgery; one case of unexplained pain,recovered after conservative treatment; one case of intraoperative injury of anterior cruciate ligament(0. 2%),treated with ligament suture during operation and the hinge brace was fixed for four weeks,and the function of the knee joint recovered. Conclusions Oxford medial unicompartmental knee arthroplasty is the best treatment for antero-medial osteoarthritis of knee,of which the clinical efficacy is reliable,and the incidence of complications is low. Mature surgical procedures can ensure good results of UKA and reduce the incidence of complications. The causes and types of complications should be carefully analyzed and appropriate treatment should be given.
引文
[1] Goodfellow J,O’connor J. The mechanics of the knee and prosthesis design[J]. J Bone Joint Surg Br,1978,60-B(3):358-369.
[2] Barrett WP,Scott RD. Revision of failed unicondylarunicompartmental knee arthroplasty[J]. J Bone Joint Surg Am,1987,69(9):1328-1335.
[3] Bae DK,Guhl JF,Keane SP. Unicompartmental knee arthroplasty for single compartment disease. Clinical experience with an average four-year follow-up study[J]. Clin Orthop Relat Res,1983,176:233-238.
[4] Riddle DL, Jiranek WA, Mcglynn FJ. Yearly incidence of unicompartmental knee arthroplasty in the United States[J]. J Arthroplasty,2008,23(3):408-412.
[5] Newman J,Pydisetty RV,Ackroyd C. Unicompartmental or total knee replacement:The 15-year results of aprospective randomized controlled trial[J]. J Bone Joint Surg Br,2009,91-B(1):52-57.
[6] Berger RA,Della Valle CJ. Unicompartmental knee arthroplasty:indications,techniques, and results[J]. Instr Course Lect,2010,59:47-56.
[7]孙海宁,于秀淳,付志厚,等.单髁关节置换治疗膝内侧骨性关节炎的中短期临床分析[J].生物骨科材料与临床研究,2015,12(2):33-36.
[8]郭万首,张启栋,刘朝晖,等.小切口单髁置换术治疗膝关节内侧间室骨关节炎94膝的中短期疗效研究[J].中国矫形外科杂志,2011,19(17):1412-1415.
[9] Epinette JA,Brunschweiler B,Mertl P,et al. French society for hip and knee. unicompartmental knee arthroplasty modes of failure:wear is not the main reason for failure:a multicentre study of 418 failed knees[J]. Orthop Traumatol Surg Res,2012,98(6Suppl):S124-130.
[10] Lombardi AV, Berend KR, Berend ME, et al. Current controversies in partial knee arthroplasty[J]. Instr Course Lect,2012,61:347-381.
[11] Lyons MC, Macdonald SJ, Somerville LE, et al.Unicompartmental versus total knee arthroplasty database analysis:is there a winner?[J]. Clin Orthop Relat Res,2012,470(1):84-90.
[12] Morris MJ, Molli RG, Berend KR, et al. Mortality and perioperative complications after unicompartmental knee arthroplasty[J]. Knee,2013,20(3):218-220.
[13]郭万首.单髁关节置换的病例选择[J/CD].中华关节外科杂志(电子版),2015,9(3):377-379.
[14] Ewald FC. The knee society total knee arthroplasty roentgenographic evaluation and scoring system[J]. Clin Orthop Relat Res,1989,248:9-12.
[15] Dawson J,Fitzpatrick R,Murray D,et al. Questionnaire on the perceptions of patients about total knee replacement[J]. J Bone Joint Surg Br,1998,80(1):63-69.
[16] White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee[J]. J Bone Joint Surg Br,1991,73(4):582-586.
[17] Scott RD, Joyce MJ, Ewald FC, et al. Mc Keever metallic hemiarthroplasty of the knee in unicompartmental degenerative arthritis. Long-term clinical follow-up and current indications[J].J Bone Joint Surg Am,1985,67(2):203-207.
[18] Goodfellow JW,Kershaw CJ,Benson MK,et al. The Oxford knee for unicompartmental osteoarthritis. the first 103 cases[J]. J Bone Joint Surg Br,1988,70(5):692-701.
[19] Murray DW,Goodfellow JW,O’connor JJ. The Oxford medial unicompartmental arthroplasty:a ten-year survival study[J]. J Bone Joint Surg Br,1998,80(6):983-989.
[20] Price AJ,Webb J,Topf H,et al. Rapid recovery after Oxford unicompartmentalarthroplasty through a short incision[J]. J Arthroplasty,2001,16(8):970-976.
[21] Panni AS,Vasso PM,Cerciello S,et al. Unicompartmental knee replacement provides early clinical and functional improvement stabilizing over time[J]. Knee Surg Sports Traumatol Arthrosc,2012,20(3):579-585.
[22] Dervin GF,Carruthers C,Feibel RJ,et al. Initial experience with the Oxford unicompartmental knee arthroplasty[J]. J Arthroplasty,2011,26(2):192-197.
[23] Sv@rd UC, Price AJ. Oxford medial unicompartmental knee arthroplasty. A survival analysis of an Independent series[J]. J Bone Joint Surg Br,2001,83(2):191-194.
[24] Price AJ,Waite JC,Svard U. Long-term clinical results of the medial Oxford unicompartmental knee arthroplasty[J]. Clin Orthop Relat Res,2005,435:171-180.
[25] Price AJ,Svard U. A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty[J]. Clin Orthop Relat Res,2011,469(1):174-179.
[26] Pandit H,Hamilton TW,Jenkins C,et al. The clinical outcome of minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty:a 15-year follow-up of 1000 UKAs[J]. Bone Joint J,2015,97-B(11):1493-1500.
[27] Rajasekhar C, Das S, Smith A. Unicompartmental knee arthroplasty. 2-to 12-year results in a community hospital[J]. J Bone Joint Surg Br,2004,86(7):983-985.
[28] Pandit H, Jenkins C, Barker K, et al. The Oxford medial unicompartmental knee replacement using a minimally-invasive approach[J]. J Bone Joint Surg Br,2006,88(1):54-60.
[29] Vorlat P, Putzeys G, Cottenie D, et al. The Oxford unicompartmental knee prosthesis:an Independent 10-year survival analysis[J]. Knee Surgery Sports Traumatol Arthrosc,2006,14(1):40-45.
[30] Pandit H,Jenkins C,Gill HS,et al. Minimally invasive Oxford phase 3 unicompartmental knee replacement:results of 1000 cases[J]. J Bone Joint Surg Br,2011,93(2):198-204.
[31] Lim HC, Bae JH, Song SH, et al. Oxford phase 3unicompartmental knee replacement in Korean patients[J]. J Bone Joint Surg Br,2012,94(8):1071-1076.
[32] Kim KT,Lee S,Kim JH,et al. The survivorship and clinical results of minimally invasive unicompartmental knee arthroplasty at10-Year follow-up[J]. Clin Orthop Surg,2015,7(2):199-206.
[33] Bottomley N,Jones LD,Rout R,et al. A survival analysis of1084 knees of the Oxford unicompartmental knee arthroplasty:a comparison between consultant and trainee surgeons[J]. Bone Joint J,2016,98B(B):22-27.
[34] Emerson RH,Alnachoukati O,Barrington J,et al. The results of Oxford unicompartmental knee arthroplasty in the United States s:a mean ten-year survival analysis[J]. Bone Joint J,2016,98B(10 Supple B):34-40.
[35] Lisowski LA,Meijer LI,Bekerom MP,et al. Ten-to 15-year results of the Oxford Phase III Mobile unicompartmental knee arthroplasty:a prospective study from a non-designer group[J].Bone Joint J,2016,98-B(10 Supple B):41-47.
[36]徐明,惠文鹏,王冰,等. 114例单髁膝关节置换中期疗效及其与学习曲线的关系[J].生物骨科材料与临床研究,2015,12(1):25-28.
[37] Vardi G,Strover AE. Early complications of unicompartmental knee replacement:the Droitwich experience[J]. Knee,2004,11(5):389-394.
[38] Kim KT, Lee S, Ji LE, et al. Analysis and treatment of complications after unicompartmental knee arthroplasty[J]. Knee Surg Relat Res,2016,28(1):46-54.
[39] Choy WS,Kim KJ,Lee SK,et al. Medial unicompartmental knee arthroplasty in patients with spontaneous osteonecrosis of the knee[J]. Clin Orthop Surg,2011,3(4):279-284.
[40] Guo WS, Zhang QD, Liu ZH, et al. Minimally invasive unicompartmental knee arthroplasty for spontaneous osteonecrosis of the knee[J]. Orthop Surg,2015,7(2):119-124.
[41] Mancuso F,Dodd CA,Murray DW,et al. Medial unicompartmental knee arthroplasty in the ACL-deficient knee[J]. J Orthop Traumatol,2016,17(3):267-275.
[42] Hamilton WG,Collier MB,Tarabee EA,et al. Incidence and reasons for reoperation after minimally invasive unicompartmental knee arthroplasty[J]. J Arthroplasty,2006,21(6 Suppl 2):98-107.
[43] Clark M,Campbell DG,Kiss G,et al. Reintervention after Mobile-bearing Oxford Unicompartmental Knee Arthroplasty[J].Clin Orthop Relat Res,2010,468(2):576-580.
[2] Barrett WP,Scott RD. Revision of failed unicondylarunicompartmental knee arthroplasty[J]. J Bone Joint Surg Am,1987,69(9):1328-1335.
[3] Bae DK,Guhl JF,Keane SP. Unicompartmental knee arthroplasty for single compartment disease. Clinical experience with an average four-year follow-up study[J]. Clin Orthop Relat Res,1983,176:233-238.
[4] Riddle DL, Jiranek WA, Mcglynn FJ. Yearly incidence of unicompartmental knee arthroplasty in the United States[J]. J Arthroplasty,2008,23(3):408-412.
[5] Newman J,Pydisetty RV,Ackroyd C. Unicompartmental or total knee replacement:The 15-year results of aprospective randomized controlled trial[J]. J Bone Joint Surg Br,2009,91-B(1):52-57.
[6] Berger RA,Della Valle CJ. Unicompartmental knee arthroplasty:indications,techniques, and results[J]. Instr Course Lect,2010,59:47-56.
[7]孙海宁,于秀淳,付志厚,等.单髁关节置换治疗膝内侧骨性关节炎的中短期临床分析[J].生物骨科材料与临床研究,2015,12(2):33-36.
[8]郭万首,张启栋,刘朝晖,等.小切口单髁置换术治疗膝关节内侧间室骨关节炎94膝的中短期疗效研究[J].中国矫形外科杂志,2011,19(17):1412-1415.
[9] Epinette JA,Brunschweiler B,Mertl P,et al. French society for hip and knee. unicompartmental knee arthroplasty modes of failure:wear is not the main reason for failure:a multicentre study of 418 failed knees[J]. Orthop Traumatol Surg Res,2012,98(6Suppl):S124-130.
[10] Lombardi AV, Berend KR, Berend ME, et al. Current controversies in partial knee arthroplasty[J]. Instr Course Lect,2012,61:347-381.
[11] Lyons MC, Macdonald SJ, Somerville LE, et al.Unicompartmental versus total knee arthroplasty database analysis:is there a winner?[J]. Clin Orthop Relat Res,2012,470(1):84-90.
[12] Morris MJ, Molli RG, Berend KR, et al. Mortality and perioperative complications after unicompartmental knee arthroplasty[J]. Knee,2013,20(3):218-220.
[13]郭万首.单髁关节置换的病例选择[J/CD].中华关节外科杂志(电子版),2015,9(3):377-379.
[14] Ewald FC. The knee society total knee arthroplasty roentgenographic evaluation and scoring system[J]. Clin Orthop Relat Res,1989,248:9-12.
[15] Dawson J,Fitzpatrick R,Murray D,et al. Questionnaire on the perceptions of patients about total knee replacement[J]. J Bone Joint Surg Br,1998,80(1):63-69.
[16] White SH, Ludkowski PF, Goodfellow JW. Anteromedial osteoarthritis of the knee[J]. J Bone Joint Surg Br,1991,73(4):582-586.
[17] Scott RD, Joyce MJ, Ewald FC, et al. Mc Keever metallic hemiarthroplasty of the knee in unicompartmental degenerative arthritis. Long-term clinical follow-up and current indications[J].J Bone Joint Surg Am,1985,67(2):203-207.
[18] Goodfellow JW,Kershaw CJ,Benson MK,et al. The Oxford knee for unicompartmental osteoarthritis. the first 103 cases[J]. J Bone Joint Surg Br,1988,70(5):692-701.
[19] Murray DW,Goodfellow JW,O’connor JJ. The Oxford medial unicompartmental arthroplasty:a ten-year survival study[J]. J Bone Joint Surg Br,1998,80(6):983-989.
[20] Price AJ,Webb J,Topf H,et al. Rapid recovery after Oxford unicompartmentalarthroplasty through a short incision[J]. J Arthroplasty,2001,16(8):970-976.
[21] Panni AS,Vasso PM,Cerciello S,et al. Unicompartmental knee replacement provides early clinical and functional improvement stabilizing over time[J]. Knee Surg Sports Traumatol Arthrosc,2012,20(3):579-585.
[22] Dervin GF,Carruthers C,Feibel RJ,et al. Initial experience with the Oxford unicompartmental knee arthroplasty[J]. J Arthroplasty,2011,26(2):192-197.
[23] Sv@rd UC, Price AJ. Oxford medial unicompartmental knee arthroplasty. A survival analysis of an Independent series[J]. J Bone Joint Surg Br,2001,83(2):191-194.
[24] Price AJ,Waite JC,Svard U. Long-term clinical results of the medial Oxford unicompartmental knee arthroplasty[J]. Clin Orthop Relat Res,2005,435:171-180.
[25] Price AJ,Svard U. A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty[J]. Clin Orthop Relat Res,2011,469(1):174-179.
[26] Pandit H,Hamilton TW,Jenkins C,et al. The clinical outcome of minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty:a 15-year follow-up of 1000 UKAs[J]. Bone Joint J,2015,97-B(11):1493-1500.
[27] Rajasekhar C, Das S, Smith A. Unicompartmental knee arthroplasty. 2-to 12-year results in a community hospital[J]. J Bone Joint Surg Br,2004,86(7):983-985.
[28] Pandit H, Jenkins C, Barker K, et al. The Oxford medial unicompartmental knee replacement using a minimally-invasive approach[J]. J Bone Joint Surg Br,2006,88(1):54-60.
[29] Vorlat P, Putzeys G, Cottenie D, et al. The Oxford unicompartmental knee prosthesis:an Independent 10-year survival analysis[J]. Knee Surgery Sports Traumatol Arthrosc,2006,14(1):40-45.
[30] Pandit H,Jenkins C,Gill HS,et al. Minimally invasive Oxford phase 3 unicompartmental knee replacement:results of 1000 cases[J]. J Bone Joint Surg Br,2011,93(2):198-204.
[31] Lim HC, Bae JH, Song SH, et al. Oxford phase 3unicompartmental knee replacement in Korean patients[J]. J Bone Joint Surg Br,2012,94(8):1071-1076.
[32] Kim KT,Lee S,Kim JH,et al. The survivorship and clinical results of minimally invasive unicompartmental knee arthroplasty at10-Year follow-up[J]. Clin Orthop Surg,2015,7(2):199-206.
[33] Bottomley N,Jones LD,Rout R,et al. A survival analysis of1084 knees of the Oxford unicompartmental knee arthroplasty:a comparison between consultant and trainee surgeons[J]. Bone Joint J,2016,98B(B):22-27.
[34] Emerson RH,Alnachoukati O,Barrington J,et al. The results of Oxford unicompartmental knee arthroplasty in the United States s:a mean ten-year survival analysis[J]. Bone Joint J,2016,98B(10 Supple B):34-40.
[35] Lisowski LA,Meijer LI,Bekerom MP,et al. Ten-to 15-year results of the Oxford Phase III Mobile unicompartmental knee arthroplasty:a prospective study from a non-designer group[J].Bone Joint J,2016,98-B(10 Supple B):41-47.
[36]徐明,惠文鹏,王冰,等. 114例单髁膝关节置换中期疗效及其与学习曲线的关系[J].生物骨科材料与临床研究,2015,12(1):25-28.
[37] Vardi G,Strover AE. Early complications of unicompartmental knee replacement:the Droitwich experience[J]. Knee,2004,11(5):389-394.
[38] Kim KT, Lee S, Ji LE, et al. Analysis and treatment of complications after unicompartmental knee arthroplasty[J]. Knee Surg Relat Res,2016,28(1):46-54.
[39] Choy WS,Kim KJ,Lee SK,et al. Medial unicompartmental knee arthroplasty in patients with spontaneous osteonecrosis of the knee[J]. Clin Orthop Surg,2011,3(4):279-284.
[40] Guo WS, Zhang QD, Liu ZH, et al. Minimally invasive unicompartmental knee arthroplasty for spontaneous osteonecrosis of the knee[J]. Orthop Surg,2015,7(2):119-124.
[41] Mancuso F,Dodd CA,Murray DW,et al. Medial unicompartmental knee arthroplasty in the ACL-deficient knee[J]. J Orthop Traumatol,2016,17(3):267-275.
[42] Hamilton WG,Collier MB,Tarabee EA,et al. Incidence and reasons for reoperation after minimally invasive unicompartmental knee arthroplasty[J]. J Arthroplasty,2006,21(6 Suppl 2):98-107.
[43] Clark M,Campbell DG,Kiss G,et al. Reintervention after Mobile-bearing Oxford Unicompartmental Knee Arthroplasty[J].Clin Orthop Relat Res,2010,468(2):576-580.