摘要目的 探讨髌股关节退变程度对活动平台人工单髁关节置换手术临床疗效的影响。方法 回顾性分析2007年4月至2017年4月应用Oxford活动平台人工单髁关节置换手术治疗膝内侧间室骨关节炎共500例患者，其中男176例，女324例；年龄43~91岁，平均(61.12±8.63)岁。根据髌股关节影像学分级将不同退变程度的患者分为4组，0~1级组104例，2级组179例，3级组182例，4级组35例。通过膝关节活动度(range of movement，ROM)、膝关节功能评分(knee society score，KSS)与牛津膝关节评分(Oxford knee score，OKS)评估临床疗效，记录术后并发症的发生，采用KaplanMeier生存分析的方法统计各组单髁关节假体生存率，采用配对样本 t 检验比较术前与术后的ROM、KSS、OKS变化，采用单因素方差分析比较不同髌股关节退变分组之间术后ROM、KSS、OKS的差异。结果 本组患者均获得有效随访，随访时间2~12年，平均(6.27±1.97)年。KSS评分由术前平均(59.03±5.59)分，改善至术后平均(93.80±3.45)分(t＝－116.09，P＜0.05)；OKS评分由术前平均(23.83±2.45)分，提高至术后平均(45.61±3.83)分(t＝－110.23，P＜0.05)；膝关节ROM术前平均(110.40±6.84)°，术后平均(117.11±9.68)°(t＝－12.88，P＜0.05，见表1)。膝关节单髁置换手术(unicompartmental knee arthroplasty，UKA)十年假体生存率为96.0%，髌股关节0~1级组假体生存率为98.9%，2级组为92.7%，3级组为97.8%，4级组为96.0%。髌股关节不同程度的退变并未影响人工单髁关节假体生存率，差异无统计学意义。在临床疗效方面，尽管影像学分期患者术后ROM及KSS评分均未发现显著不同，但髌股关节退变程度对术后OKS评分有显著影响，差异有统计学意义。结论 髌股关节退变不影响UKA假体生存率，不应作为UKA手术禁忌证，髌股关节影像学分级4级退变时，术后临床效果要稍差，重度髌股关节外侧间隙退变患者选择UKA手术仍需慎重，通过术前髌股关节影像学分级辅助UKA术前评估可靠有效。
Abstract：Objective To investigate the effect of patellofemoral joint degeneration on the clinical outcome of Oxford unicompartmental knee arthroplasty.Methods A retrospective analysis was performed in 500 patients with medial compartment osteoarthritis of the knee treated by Oxford unicompartmental knee arthroplasty between April 2007 and April 2017.There were 176 males and 324 females with an average age of (61.12±8.63)(range：43~91).According to the roentgenographic grading of patellofemoral joint，there were 4 groups.There were 104 cases in grade 0~1 group，179 cases in grade 2 group，182 cases in grade 3 group and 35 cases in grade 4 group.The clinical treatment was evaluated by ROM，KSS and OKS.The long-term survival rate of prosthesis，on survival rate were evaluated by Kaplan-Meier survival analysis.The changes of ROM，KSS and OKS before and after were compared bypaired sample ttest.The changes of ROM，KSS and OKS after operation between differentgroups of patellofemoral joint degeneration were compared by One-way ANOVA. Results The follow-up time from 2 to 12 years，with an average of (6.27±1.97)years.The KSS score improved from (59.03±5.59)points before operation to (93.80±3.45)points after operation(t＝－116.09，P＜0.05)；the OKS score increased from (23.83±2.45)points before operation to (45.61±3.83)points after operation (t＝－110.23，P＜0.05)；the ROM of knee joint was (110.40±6.84)degrees before operation and (117.11±9.68)degrees after operation (t＝－12.88，P＜0.05).The 10-year survival rate of prosthesis was 96.0%.The survival rate of prosthesis was 98.9% in grade 0~1 group，92.7% in grade 2 group，97.8% in grade 3 group，96.0% in grade 4 group，there was no significant difference；ROM and KSS of patients in all groups were not significantly different；OKS of grade 4 group were significantly decreased，the difference was significant.Conclusion The Patellofemoral joint degeneration did not affect UKA prostheses survival，should not be regarded as a contraindication for UKA. In grade 4 degeneration of patellofemoral joint, postoperative clinical effect is a bit poor. Patients with severe degeneration of the lateral patellofemoral joint, the selection of UKA surgery still need to be cautious.Preoperative assessment of UKA by patellofemoral joint roentgenographic grading is reliable and efficient.
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