摘要目的 调查影响单髁置换术(unicompartmental knee arthroplasty,UKA)治疗膝前内侧骨关节炎术后临床疗效的影响因素。方法 回顾性分析2019年1月至2020年12月期间在石家庄市人民医院骨科采用UKA治疗的90例(136膝)膝前内侧骨关节炎患者资料,其中男21例(32膝),女69例(104膝);年龄52~75岁,平均(63.8±6.0)岁。分析患者年龄、性别、侧别、合并内科疾病、合并髌骨关节炎、骨密度(bone mineral density,BMD)、身体质量指数(body mass index,BMI)、预后营养指数(prognostic nutritional index,PNI)、软骨磨损程度、前交叉韧带(anterior cruciate ligament,ACL)功能、术前美国特种外科医院(hospital for special surgery,HSS)膝关节评分、疼痛视觉模拟评分(visual analogue scale,VAS)、膝关节活动度(range of motion,ROM)等资料。根据术后HSS评分分为优良组及非优良组,通过Logistic回归分析筛选影响术后膝关节功能的主要因素。结果 全部患者均获随访,随访时间15~21个月,平均(17.4±2.0)个月。UKA优良率为83.8%。单因素分析结果显示:术前软骨磨损程度、BMD、BMI、术前VAS与术后膝关节功能恢复有关,差异有统计学意义(P<0.05);多因素Logistic回归分析结果表明:术前软骨磨损程度、BMI、术前VAS评分是影响术后膝关节功能的独立危险因素(P<0.05)。PNI同部分软骨磨损存在交互作用(P<0.05)。结论 (1)UKA治疗膝前内侧骨关节炎优良率较高;(2)BMI<30 kg/m2、术前VAS<5分、全层软骨磨损是UKA术后疗效的保护因素;(3)营养因素不可忽视,关注术前营养因素可提高UKA术后疗效的优良率。
[1]Radhakrishnan GT,Magan A,Kayani B,et al.Return to sport after unicompartmental knee arthroplasty:A systematic review and metaanalysis[J].Orthop J Sports Med,2022,10(3):951684341.
[2]Wilson HA,Middleton R,Abram SGF,et al.Patient relevant outcomes of unicompartmental versus total knee replacement:Systematic review and metaanalysis[J].BMJ,2019(364):1352.
[3]Kozinn SC,Marx C,Scott RD.Unicompartmental knee arthroplasty.A 4.5-6-year follow-up study with a metal-backed tibial component[J].J Arthroplasty,1989(4 Suppl):S1-S10.
[4]Johal S,Nakano N,Baxter M,et al.Unicompartmental knee arthroplasty:The past,current controversies,and future perspectives[J].J Knee Surg,2018,31(10):992-998.
[5]Maier MW,Kuhs F,Streit MR,et al.Unicompartmental knee arthroplasty in patients with full versus partial thickness cartilage loss (PTCL):Equal in clinical outcome but with higher reoperation rate for patients with PTCL[J].Arch Orthop Trauma Surg,2015,135(8):1169-1175.
[6]邓华梅,袁札根,李治敏,等.基于国人172例第3代Oxford单髁膝关节置换术探索手术器械配套规律[J].中华生物医学工程杂志,2022,28(1):65-68.
[7]李亚坤,李浩,王浩浩,等.术前不同程度下肢力线内翻畸形对单髁置换术后短期疗效的影响分析[J].实用骨科杂志,2020,26(12):1064-1069.
[8]Deckard ER,Jansen K,ZiembaDavis M,等.髌股关节退变对膝关节内侧固定平台单髁置换术后疗效的影响[J].实用骨科杂志,2021,27(10):960.
[9]郭万首.单髁置换在膝关节骨关节炎治疗中的应用和争议[J].中华外科杂志,2020,58(6):411-415.
[10]Kandil A,Werner BC,Gwathmey WF,et al.Obesity,morbid obesity and their related medical comorbidities are associated with increased complications and revision rates after unicompartmental knee arthroplasty[J].J Arthroplasty,2015,30(3):456-460.
[11]高焕绅,徐熙鹏,孙一,等.体重指数对活动平台单髁置换术中长期临床结果的影响[J].中华骨与关节外科杂志,2021,14(04):251-257.
[12]Nettrour JF,Ellis RT,Hansen BJ,et al.High failure rates for unicompartmental knee arthroplasty in morbidly obese patients:A two-year minimum follow-up study[J].J Arthroplasty,2020,35(4):989-996.
[13]沈彬,翁习生,廖刃,等.中国髋、膝关节置换术加速康复——围术期疼痛与睡眠管理专家共识[J].中华骨与关节外科杂志,2016,9(2):91-97.
[14]Burns LC,Ritvo SE,Ferguson MK,et al.Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty:A systematic review[J].J Pain Res,2015(8):21-32.
[15]刘威,李文龙,丁娟,等.全膝关节置换术后慢性疼痛的非手术影响因素研究进展[J].中医正骨,2022,34(8):59-61.
[16]Khatib Y,Madan A,Naylor JM,et al.Do psychological factors predict poor outcome in patients undergoing TKA?A systematic review[J].Clin Orthop Relat Res,2015,473(8):2630-2638.
[17]Larsen DB,Laursen M,Edwards RR,et al.The combination of preoperative pain,conditioned pain modulation,and pain catastrophizing predicts postoperative pain 12 months after total knee arthroplasty[J].Pain Med,2021,22(7):1583-1590.
[18]Pandit H,Gulati A,Jenkins C,et al.Unicompartmental knee replacement for patients with partial thickness cartilage loss in the affected compartment[J].Knee,2011,18(3):168-171.
[19]Valdes AM,Doherty SA,Zhang W,et al.Inverse relationship between preoperative radiographic severity and postoperative pain in patients with osteoarthritis who have undergone total joint arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2012,41(4):568-575.
[20]Wylde V,Sayers A,Odutola A,et al.Central sensitization as a deter minant of patients’ benefit from total hip and knee replacement[J].Eur J Pain,2017,21(2):357-365.
[21]Mastronuzzi T,Grattagliano I.Nutrition as a health deter minant in elderly patients[J].Curr Med Chem,2019,26(19):3652-3661.
[22]程环宇,李斯明,孟庆奇,等.骨性关节炎的发病机制与炎症反应的关系[J].中外医学研究,2020,18(6):185-188.
[23]胡天野,任少君,林道超.预后营养因子PNI对老年髋部骨折预后的预测价值[J].实用骨科杂志,2019,25(8):686-689.
[24]Yoneda T,Hata K,Nakanishi M,et al.Involvement of acidic microenvironment in the pathophysiology of cancer-associated bone pain[J].Bone,2011,48(1):100-105.