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摘要 膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)是治疗膝关节前内侧骨关节炎(anteromedial osteoarthritis,AMOA)的一种有效治疗方式。UKA术后膝关节运动学与自然膝关节的运动学相似,术后功能优于全膝关节置换术。严格的手术适应证是获得满意临床结果的前提。然而,前交叉韧带缺失(anterior cruciate ligament deficiency,ACLD)被认为是UKA的禁忌证,ACLD情况下股骨反复的后脱位导致关节退变和胫骨平台后内侧关节软骨磨损,出现膝骨关节炎的概率是ACL完整情况下的10倍。终末期AMOA合并ACLD的最佳治疗方式仍然有争议,包括单独UKA术治疗、UKA联合膝关节前交叉韧带重建术(anterior cruciate ligament reconstruction,ACLR)治疗、单独胫骨高位截骨术(high tibial osteotomy,HTO)治疗、HTO联合ACLR治疗以及全膝关节置换术治疗。研究报道HTO联合ACLR的并发症发生率是单独UKA的3倍,主要原因是韧带重建失败。
对于膝骨关节炎合并ACLD的治疗,目前主流观点仍然是进行全膝关节置换术。但是在一些特殊的情况下,即使合并ACLD也可以考虑UKA治疗,主要包括两种情况:(1)针对高龄体弱患者。这类患者如果直接进行全膝关节置换术,并发症发生率和患者死亡率会明显升高,相对微创的UKA成为一种很有价值的治疗方式。从临床实践经验和文献报道临床结果来看,高龄膝骨关节炎患者即使出现ACL断裂,大多数膝关节由于骨关节炎的存在,稳定性仍然良好,虽然ACL缺失,但是膝关节活动度良好(髌骨内侧副韧带无挛缩),外侧间室良好。因此UKA也不是绝对的禁忌证,尤其适合高龄、活动能力弱、不能耐受长时间手术的患者。(2)年轻患者先由于外伤等原因出现ACL断裂,继而发展为骨关节炎。这类患者经常存在膝关节不稳定,单纯行UKA治疗不稳定和脱位有较高风险;但是如果直接行全膝关节置换术,由于患者年轻活跃,会导致术后翻修率较高,且翻修的平均时间也会提前。这类患者可能适合UKA联合ACL重建,在重建稳定性的同时,解决患者的单间室磨损问题。现将两种治疗方式研究进展进行综述。
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基金资助:内蒙古自治区高等学校科学研究项目重点项目(NJZZ21034)
内蒙古自治区卫生健康委医疗卫生科技计划项目(20210601)
内蒙古自然科学基金(2020MS08054)
内蒙古医科大学青年创新基金项目(YKD2018QNCX076) |
通讯作者:
柳剑
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作者简介: 张峻(1985- ),男,副主任医师,内蒙古医科大学附属医院骨科,zhangjunhaodoctor@163.com |
[1]Mancuso F,Hamilton TW,Kumar V,et al.Clinical outcome after UKA and HTO in ACL deficiency:A systematic review[J].Knee Surg Sports Traumatol Arthrosc,2016,24(1):112-122.
[2]Volpin A,Kini SG,Meuffels DE.Satisfactory outcomes following combined unicompartmental knee replacement and anterior cruciate ligament reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2018,26(9):2594-2601.
[3]McDaniel WJ Jr,Dameron TB Jr.The untreated anterior cruciate ligament rupture[J].Clin Orthop Relat Re,1983(172):158-163.
[4]Vajapey SP,Alvarez PM,Greco NJ,et al.Medial osteoarthritis in an ACLDeficient Knee:A Critical Analysis Review[J].JBJS Rev,2021,9(3).doi:10.2106/JBJS.RVW.20.00132.
[5]Stern SH,Becker MW,Insall JN.Unicondylar knee arthroplasty.An evaluation of selection criteria[J].Clin Orthop Relat Res,1993(286):143-148.
[6]Kozinn SC,Scott R.Unicondylar knee arthroplasty[J].J Bone Joint Surg Am,1989,71(1):145-150.
[7]Pandit H,Jenkins C,Gill HS,et al.Unnecessary contraindications for mobilebearing unicompartmental knee replacement[J].J Bone Joint Surg Br,2011,93(5):622-628.
[8]Christensen NO.Unicompartmental prosthesis for gonarthrosis.A nine-year series of 575 knees from a Swedish hospital[J].Clin Orthop Relat Res,1991(273):165-169.
[9]Shao Q,MacLeod TD,Manal K,et al.Estimation of ligament lkoading and anterior tibial translation in healthy and ACL deficient knees during gait and the influence of increasing tibial slope using EMG driven approach[J].Ann Biomed Eng,2011,39(1):110-121.
[10]Vasso M,Corona K,Gomberg B,et al.European knee associates small implants focus group.Obesity increases the risk of conversion to total knee arthroplasty after unicompartimental knee arthroplasty:a metaanalysis[J].Knee Surg Sports Traumatol Arthrosc,2021 Oct 31.Epub ahead of print.
[11]Engh GA,Ammeen DJ.Unicondylar arthroplasty in knees with deficient anterior cruciate ligaments[J].Clin Orthop Relat Res,2014,472(1):73-77.
[12]Plancher KD,Dunn AS,Petterson SC.The anterior cruciate ligament-deficient knee and unicompartmental arthritis[J].Clin Sports Med,2014,33(1):43-55.
[13]Zumbrunn T,Schütz P,von Knoch F,et al.Medial unicompartmental knee arthroplasty in ACL deficient knees is a viable treatment option:In vivo kinematic evaluation using a moving fluoroscope[J].Knee Surg Sports Traumatol Arthrosc,2020,28(6):1765-1773.
[14]Plancher KD,Brite JE,Briggs KK,et al.Patient acceptable symptom state for reporting outcomes following unicompartmental knee arthroplasty:A matched pair analysis comparing UKA in ACL deficient versus ACL intact knees[J].Bone Joint J,2021,103B(8):1367-1372.
[15]Bull D,Mannan A,Ansari J,et al.Medial/central PF arthritis and functionally stable ACL deficiency do not compromise outcomes of fixed-bearing medial UKA[J].Knee,2022(35):8-15.
[16]Suter L,Roth A,Angst M,et al.Is ACL deficiency always a contraindication for medial UKA?Kinematic and kinetic analysis of implanted and contralateral knees[J].Gait Posture,2019(68):244-251.
[17]Kwon HM,Kang KT,Kim JH,et al.Medial unicompartmental knee arthroplasty to patients with a ligamentous deficiency can cause biomechanically poor outcomes[J].Knee Surg Sports Traumatol Arthrosc,2020,28(9):2846-2853.
[18]Tian S,Wang B,Wang Y,et al.Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction in knees with osteoarthritis and deficient anterior cruciate ligament[J].BMC Musculoskelet Disord,2016(17):327.
[19]Ventura A,Legnani C,Terzaghi C,et al.Medial unicondylar knee arthroplasty combined to anterior cruciate ligament reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2017,25(3):675-680.
[20]Iriberri I,Suau S,Payan L,et al.Longterm deterioration after one-stage unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction[J].Musculoskelet Surg,2019,103(3):251-256.
[21]Aslan H,Cevik HB.Outcomes of combined unicondylar knee arthroplasty and anterior cruciate ligament reconstruction[J].J Knee Surg,2022,35(10):1087-1090.
[22]Kikuchi K,Hiranaka T,Kamenaga T,et al.Anterior cruciate ligament deficiency is not always a contraindication for medial unicompartmental knee arthroplasty:A retrospective study in nondesigner's Japanese hospital[J].J Arthroplasty,2021,36(2):495-500.
[23]Albo E,Campi S,Zampogna B,et al.Results of simultaneous unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction:A systematic review[J].J Clin Med,2021,10(19):4290.
[24]Derreveaux V,Schmidt A,Shatrov J,et al.Combined procedures with unicompartmental knee arthroplasty:High risk of stiffness but promising concept in selected indications[J].SICOT J,2022(8):4.
[25]Tecame A,Savica R,Rosa MA,et al.Anterior cruciate ligament reconstruction in association with medial unicompartmental knee replacement:A retrospective study comparing clinical and radiological outcomes of two different implant design[J].Int Orthop,2019,43(12):2731-2737.
[26]Haffar A,Ali R,Mehta N,et al.Prior anterior cruciate ligament reconstruction does not compromise the functional outcomes of medial unicompartmental knee arthroplasty although revision for progressive arthritis may occur earlier[J]J Arthroplasty,2022,37(2):238-242.
[27]Pandit H,Van Duren BH,Gallagher JA,et al.Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty:In vivo kinematics[J].Knee,2008,15(2):101-106.
[28]Citak M,Bosscher MR,Citak M,et al.Anterior cruciate ligament reconstruction after unicompartmental knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2011,19(10):1683-1688.
[29]Tinius M,Hepp P,Becker R.Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2012,20(1):81-87. |
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