膝关节骨关节炎患者行单侧膝关节置换术后对侧膝关节力线的变化

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摘要目的分析膝关节骨关节炎患者行单侧膝关节置换术后对侧膝关节力线变化，并比较K-L分级(Kellgren-Lawrence grade)对于对侧膝关节力线变化的影响。方法回顾性分析我院运动医学与成人重建外科2017年1月至2018年4月行初次单侧膝关节置换术的患者157例，分为A组(K-L分级≤2级)和B组(K-L分级＞2级)，对比两组对侧术后-术前髋-膝-踝角(hip-knee-ankle angle，HKA)、机械轴偏离度(mechanical axis deviation，MAD)、膝关节间隙(joint space width，JSW)、股骨远端外侧角(lateral distal femur angle，LDFA)、胫骨近端内侧角(medial proximal tibial angle，MPTA)、关节线相交角(joint line convergence angle，JLCA)及术后-术前双下肢长度差值(leg-length discrepancy，LLD)。分析对侧力线变化与术侧力线变化的关系，并比较不同手术方式(全膝关节置换术、单髁置换术)对于对侧力线变化的影响。结果两组在性别、年龄、身体质量指数(body mass index，BMI)、手术方式、术者中比较，差异无统计学意义。A组对侧术后-术前MAD、HKA分别是(－2.3±7.6)mm、(－0.6±1.0)°；B组对侧术后-术前MAD、HKA分别是(－8.0±14.3)mm、(－1.0±1.3)°，两组2项指标比较，差异有统计学意义(P＜0.05)。A组对侧术后-术前JSW、LDFA、MPTA、JLCA分别为(0.6±1.2)mm、(0.4±1.6)°、(0.2±2.1)°、(－0.2±2.0)°；B组对侧术后-术前对侧JSW、LDFA、MPTA、JLCA分别为(0.6±1.4)mm、(0.4±1.7)°、(－0.1±2.2)°、(－0.4±2.3)°，两组4项指标比较，差异无统计学意义(P＞0.05)。A组术后-术前LLD(－3.5±6.5)mm，B组为(－5.6±12.2)mm，两组比较差异无统计学意义(P＞0.05)。术侧术后-术前HKA、MAD均与对侧术后术前MAD之间呈正相关。采用全膝关节置换术或单髁置换术的患者对侧膝关节力线变化差异无统计学意义。结论膝关节骨关节炎患者行单侧膝关节置换术后，对侧膝关节力线有所改善，并且不受手术方式的影响。其中较高K-L分级的患者改善明显，同时术侧HKA、MAD的改善与对侧MAD的改善呈正相关，需要进一步研究证明这一改善是否会延缓对侧膝关节骨关节炎的进展。

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关键词 ：膝关节置换术, 力线, 骨关节炎, 对侧膝关节

Abstract：Objective To study the radiographic changes of knee alignment in nonoperative contralateral knee after unilateral knee arthroplasty due to knee osteoarthritis and analyze the effect of K-L grade (Kellgren-Lawrence grade) on the radiographic changes of knee alignment in nonoperative contralateral knee after unilateral knee arthroplasty.Methods A total of 157 patients undergoing primary unilateral knee arthroplasty between January 2017 and April 2018 in the Department of Sports Medicine and Adult Reconstructive Surgery of Drum Tower Hospital were retrospectively analyzed，including 62 patients with K-L grade 1 to 2 (group A) and 95 patients with K-L grade 3 to 4 (group B).Postoperative change of hip-knee-angle (HKA)，mechanical axis deviation (MAD)，joint space width (JSW)，lateral distal femur angle (LDFA)，medial proximal tibial angle (MPTA)，joint line convergence angle (JLCA) in contralateral knee and postoperative change of leg-length discrepancy (LLD) were compared between the two groups and analyze the relation between postoperative change of knee alignment in operative knee and contralateral knee.Postoperative changes of knee alignment in contralateral knee was compared between patients under total knee arthroplasty (TKA) and patients under unicompartmental knee arthroplasty(UKA).Results There was no statistically difference between the two groups regarding gender，age，body mass index (BMI)，surgical methods and surgeon.Postoperative change of contralateral knee MAD，HKA in group A was (－2.3±7.6)mm，(－0.6±1.0)°，compared to that of group B (－8.0±14.3)mm，(－1.0±1.3)°，showing statistical significance (P＜0.05).Postoperative change of contralateral knee JSW，LDFA，MPTA，JLCA in group A was (0.6±1.2)mm，(0.4±1.6)°，(0.2±2.1)°，(－0.2±2.0)°，compared to that of group B (0.6±1.4)mm，(0.4±1.7)°，(－0.1±2.2)°，(－0.4±2.3)°，showing no statistical significance (P＞0.05).Postoperative change of LLD in group A was (－3.5±6.5)mm，compared to that of group B(－5.6±12.2)mm，showing no statistical significance (P＞0.05).The relation between postoperative change of MAD in operative knee and postoperative change of HKA in contralateral knee were in positive correlation(P＜0.05)，and postoperative change of MAD in operative knee and postoperative change of MAD in contralateral knee were in positive correlation(P＜0.05).Postoperative changes of knee alignment between patients under total knee arthroplasty(TKA) and patients under unicompartmental knee arthroplasty(UKA) showed no statistical significance (P＞0.05).Conclusion patients with knee osteoarthritis who undergo unilateral knee arthroplasty，improvement of contralateral mechanical axis can be measured radiographically，with more change in K-L grade 3 to 4 than K-L grade 1 to 2，which will not be influenced by surgical methods.Postoperative change of HKA，MAD in operative knee and postoperative change of MAD in contralateral knee are in positive correlation respectively.Further research is necessary to determine whether this improvement may delay the progression of contralateral knee osteoarthritis.

Key words： knee arthroplasty alignment osteoarthritis contralateral knee

基金资助:江苏省重点研发专项资金(BE2016608)

通讯作者: 陈东阳

作者简介: 吴宗方(1993－ )，男，研究生在读，南京医科大学鼓楼临床医学院运动医学与成人重建外科，210008。

引用本文:

吴宗方，秦江辉，蒋青，徐志宏，史冬泉，陈东阳 *. 膝关节骨关节炎患者行单侧膝关节置换术后对侧膝关节力线的变化[J]. 实用骨科杂志, 2019, 25(2): 117-122.
Wu Zongfang，Qin Jianghui，Jiang Qing，et al. Radiographic Changes of Knee Alignment in Contralateral Knee After Unilateral Total Knee Arthroplastyin Knee Osteoarthritis Patients. sygkzz, 2019, 25(2): 117-122.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I2/117

［1］Ritter MA，Keating EM，Sueyoshi T，et al.Twenty-five-years and great result after nonmodular cemented total knee arthroplasty［J］.J Arthroplasty，2016，31(10)：2199-2202.
［2］尹海波，孙俊英，赵锡江，等.全膝置换术治疗类风湿与退变性膝关节炎的比较研究［J］.实用骨科杂志，2017，23(2)：128-133.
［3］Smith HK，Wylde V，Lingard EA，et al.The effect of pain after total knee arthroplasty on the contralateral，nonreplaced knee［J］.J Bone Joint Surg(Am)，2013，95(4)：315-322.
［4］Farquhar S，Snyder-Mackler L.The Chitranjan Ranawat A ward：the nonoperated knee predicts function 3 years after unilateral total knee arthroplasty［J］.Clin Orthop Relat Res，2010，468(1)：37-44.
［5］杨胜松，黄雷，滕星，等.外固定架辅助髓内钉治疗膝外翻或膝内翻畸形［J］.北京大学学报(医学版)，2016，48(2)：244-249.
［6］Meermans G，Malik A，Witt J，et al.Preoperative radiographic assessment of limb-length discrepancy in total hip arthroplasty［J］.Clin Orthop Relat Res，2011，469(6)：1677-1682.
［7］Sayeed SA，Sayeed YA，Barnes SA，et al.The risk of subsequent joint arthroplasty after primary unilateral total knee arthroplasty，a 10-year study［J］.J Arthroplasty，2011，26(6)842-846.
［8］Ritter MA，Carr KD，Keating EM，et al.Long-term outcomes of contralateral knees after unilateral total knee arthroplasty for osteoarthritis［J］.J Arthroplasty，1994，9(4)：347-349.
［9］McMahon M，Block JA.The risk of contralateral total knee arthroplasty after knee replacement for osteoarthritis［J］.J Rheumatol，2003，30(8)：1822-1824.
［10］Shao Y，Zhang C，Charron KD，et al.The fate of the remaining knee(s) or hip(s) in osteoarthritic patients undergoing a primary TKA or THA［J］.J Arthroplasty，2013，28(10)：1842-1845.
［11］Sanders TL，Maradit Kremers H，Schleck CD，et al.Subsequent total joint arthroplasty after primary total knee or hip arthroplasty：a 40-year population-based study［J］.J Bone Joint Surg(Am)，2017，99(5)：396-401.
［12］Parisi TJ，Levy DL，Dennis DA，et al.Radiographic changes in nonoperative contralateral knee after unilateral total knee arthroplasty［J］.J Arthroplasty，2018，33(7S)：S116-S120.
［13］Moyer RF，Birmingham TB，Chesworth BM，et al.Alignment，body mass and their interaction on dynamic knee joint load in patients with knee osteoarthritis［J］.Osteoarthritis Cartilage，2010，18(7)：888-893.
［14］Messier SP，Pater M，Beavers DP，et al.Influences of alignment and obesity on knee joint loading in osteoarthritic gait［J］.Osteoarthritis Cartilage，2014，22(7)：912-917.
［15］Chehab EF，Favre J，Erhart-Hledik JC，et al.Baseline knee adduction and flexion moments during walking are both associated with 5 year cartilage changes in patients with medial knee osteoarthritis［J］.Osteoarthritis Cartilage，2014，22(11)：1833-1839.
［16］Kumar D，Manal KT，Rudolph KS.Knee joint loading during gait in healthy controls and individuals with knee osteoarthritis［J］.Osteoarthritis Cartilage，2013，21(2)：298-305.
［17］Hunter DJ，Le Graverand MP，Eckstein F.Radiologic markers of osteoarthritis progression［J］.Curr Opin Rheumatol，2009，21(2)：110-117.
［18］Oak SR，Ghodadra A，Winalski CS，et al.Radiographic joint space width is correlated with 4-year clinical outcomes in patients with knee osteoarthritis：data from the osteoarthritis initiative［J］.Osteoarthritis Cartilage，2013，21(9)：1185-1190.
［19］Muraki S，Akune T，En-YoY，et al.Joint space narrowing，body mass index，and knee pain：the ROAD study (OAC1839R1)［J］.Osteoarthritis Cartilage，2015，23(6)：874-881.
［20］van Raaij TM，Takacs I，Reijman M，et al.Varus inclination of the proximal tibia or the distal femur does not influence high tibial osteotomy outcome［J］.Knee Surg Sports Traumatol Arthrosc，2009，17(4)：390-395.
［21］Petersson IF，Boegard T，SaxneT，et al.Radiographic osteoarthritis of the knee classified by the Ahlback and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35-54 years with chronic knee pain［J］.Ann Rheum Dis，1997，56(8)：493-496.
［22］Lee DH，Park SC，Park HJ，et al.Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy［J］.Knee Surg Sports Traumatol Arthrosc，2016，24(12)：3704-3712.
［23］Agneskirchner JD，Hurschler C，Stukenborg-Colsman C，et al.Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics：a biomechanical study in human cadaveric knees［J］.Arch Orthop Trauma Surg，2004，124(9)：575-584.
［24］Nishida K，Matsumoto T，Takayama K，et al.Remaining mild varus limb alignment leads to better clinical outcome in total knee arthroplasty for varus osteoarthritis［J］.Knee Surg Sports Traumatol Arthrosc，2017，25(11)：3488-3494.
［25］Slevin O，Hirschmann A，Schiapparelli FF，et al.Neutral alignment leads to higher knee society scores after total knee arthroplasty in preoperatively non-varus patients：a prospective clinical study using 3D-CT［J］.Knee Surg Sports Traumatol Arthrosc，2018，26(6)：1602-1609.