髌股关节退变对活动平台人工单髁关节置换手术临床疗效的影响

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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 ttest.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.

Key words： osteoarthritis patellofemoral joint unicompartmental knee arthroplasty

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