单间室膝关节置换术治疗膝关节自发性骨坏死的疗效观察

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摘要目的评价单间室膝关节置换术(unicompartmental knee arthroplasty，UKA)治疗膝关节自发性骨坏死(spontaneous osteonecrosis of the knee，SONK)的中期疗效。方法对我院2012年1月至2018年1月确诊为SONK并接受UKA治疗的患者进行回顾性分析。共28例，男10例，女18例；年龄52~73岁，平均(63.0±5.67)岁。按Mont分级，Ⅲ期19例(67.9%)，Ⅳ期9例(32.1%)。术前通过X线和MRI检查对患者进行诊断和分期。记录指标包括膝关节活动度(range of motion，ROM)、胫股角(femorotibial angle，FTA)、疼痛视觉模拟评分(visual analogue scale，VAS)和美国特种外科医院(the hospital for special surgery，HSS)膝关节评分。结果所有患者均成功完成手术并获得随访，随访时间为(69.0±16.97)个月。末次随访时，HSS评分由(60.9±2.85)分提高到(91.1±2.57)分，P＜0.05；VAS由(6.4±0.99)分下降到(1.9±1.0)分，P＜0.05；FTA由(178.3±0.88)°改善到(176.4±0.97)°，P＜0.05；ROM(119.4±5.16)°与术前(119.6±5.30)°相比差异无统计学意义(P＝0.601)。1例坏死面积较大的患者术后出现不明原因疼痛，局部封闭注射治疗后症状改善。结论 UKA可以成功应用于晚期SONK的治疗，中期疗效值得肯定，长期生存率有待进一步的随访研究。

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	李浩
	王浩浩
	李亚坤
	张民 *

关键词 ：自发性骨坏死, 单间室膝关节置换术, 临床疗效

Abstract：Objective To evaluate the mid-term efficacy of unicompartmental knee arthroplasty(UKA) in the treatment of spontaneous osteonecrosis of the knee(SONK).Methods The patients diagnosed as SONK and received UKA in our hospital from January 2012 to January 2018 were retrospectively analyzed.A total of 28 cases，including 10 males and 18 females，aged from 52 to 73 years，with an average age of (63.0±5.67)years.There were 19 cases(67.9%) in stage Ⅲ and 9 cases (32.1%) in stage Ⅳ according to Mont grades.The patients were diagnosed and staged by X-ray and MRI examine before surgery.The range of motion(ROM)，femorotibial angle(FTA)，visual analog scale(VAS) and the hospital for special surgery(HSS) knee score were recorded.Results All patients completed the operation successfully and were followed up.The average follow-up was (69.0±16.97)months.At the last follow-up，the HSS score was increased from (60.9±2.85) to (91.1±2.57)，P＜0.05；VAS score was decreased from (6.4±0.99) to (1.9±1.0)，P＜0.05；FTA was improved from (178.3±0.88)° to (176.4±0.97)°，P＜0.05；ROM (119.4±5.16)° was not significantly different from that before surgery (119.6±5.30)°，P＝0.601.One patient with large necrotic area developed unexplainable pain after operation，and the symptoms improved after local block injection.Conclusion UKA can be successfully used in the treatment of advanced SONK，the mid-term efficacy is worth affirming，but the long-term survival rate needs further follow-up study.

Key words： spontaneous osteonecrosis unicompartmental knee arthroplasty clinical efficacy

通讯作者: 张民

作者简介: 李浩(1994－ )，男，研究生在读，山西医科大学第二医院骨科，030001。

引用本文:

李浩，王浩浩，李亚坤，张民 *. 单间室膝关节置换术治疗膝关节自发性骨坏死的疗效观察[J]. 实用骨科杂志, 2021, 27(1): 27-32.
Li Hao，Wang Haohao，Li Yakun，et al. Clinical Efficacy of Unicompartmental Knee Arthroplasty in the Treatment of Spontaneous Osteonecrosis of the Knee. sygkzz, 2021, 27(1): 27-32.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I1/27

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