本文關(guān)鍵詞： 單髁 牛津膝 脛骨假體內(nèi)外翻角 臨床療效　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:評價診斷為膝關(guān)節(jié)前內(nèi)側(cè)關(guān)節(jié)炎(Anteromedial Osteoarthtitis)患者在接受牛津膝單髁置換術(shù)(Oxford Unicompartmental Knee Arthroplasty,OUKA)后,術(shù)后隨訪的膝關(guān)節(jié)X線片上脛骨假體冠狀面影像學(xué)結(jié)果對術(shù)后臨床效果的影響。資料和方法:從2013年7月至2016年6月,從大連醫(yī)科大學(xué)附屬第二醫(yī)院共收治的141例膝關(guān)節(jié)內(nèi)側(cè)間室骨關(guān)節(jié)炎、創(chuàng)傷性關(guān)節(jié)炎、自發(fā)性骨壞死等患者中,按照納入、剔除標(biāo)準(zhǔn),篩選129人(172膝)前內(nèi)側(cè)關(guān)節(jié)炎患者納入本回顧性研究。術(shù)前完整記錄患者的HSS評分(the Hospital for Special Surgery Knee Score,HSS)和膝關(guān)節(jié)活動度(Range Of Knee Motion,ROM)。術(shù)后電話告知患者回本院門診隨診,每次隨診記錄患者的HSS評分和關(guān)節(jié)活動度。按照牛津膝關(guān)節(jié)操作手冊,分別由2名醫(yī)師對UKA患者術(shù)后的X線影像學(xué)圖像,采用“Radi Ant DICOM Viewer”軟件進行影像學(xué)測量股骨假體內(nèi)外翻角(A角)、股骨假體屈伸角(B角)、脛骨假體內(nèi)外翻角(E角)和脛骨平臺后傾角(F角)。保證將A、B、F角在目標(biāo)范圍內(nèi),將脛骨假體內(nèi)外翻角測量結(jié)果按2°為一個間隔進行分組,并根據(jù)結(jié)果范圍,將脛骨假體內(nèi)外翻角從-5°~6.35°分為6組(-5°~-3°組、-3°~-1°組、-1°~1°組、1°~3°組、3°~5°組和5°~7°組)。計量資料HSS評分和關(guān)節(jié)活動度(Range Of Motion,ROM)使用均值±標(biāo)準(zhǔn)差表示,術(shù)前術(shù)后比較采用配對t檢驗,E角各組間比較采用方差分析。比較異常值組和正常值組間差異,和比較內(nèi)翻組與外翻組間差異采用t檢驗。結(jié)果:本研究共計129人(172膝),男22人(30膝),女107人(142膝),其中左膝91例、右膝81例。隨訪時間1~34個月,平均隨訪時間為15.7個月。期間無一人死亡,無一人失隨訪。124膝滿足分組要求,術(shù)前平均ROM 109.23°(90°~135°),術(shù)后平均ROM 122.61°(90°~144°),術(shù)前和術(shù)后的ROM具有明顯統(tǒng)計學(xué)差異。術(shù)前平均HSS評分61.17分(39分~84分),術(shù)后平均HSS評分89.62分(67.3分~100分),術(shù)后HSS評分較術(shù)前明顯改善。比較脛骨假體內(nèi)外翻角的各分組時,術(shù)后ROM未見統(tǒng)計學(xué)差異,術(shù)后HSS評分具有差異,5°~7°組相比-5°~5°內(nèi)五組間的HSS評分明顯降低(P㩳0.05),而五組相互之間無統(tǒng)計學(xué)差異(P0.05)。比較內(nèi)翻組(89.82±5.02)和外翻組(89.12±7.10)之間的術(shù)后HSS評分和ROM未見統(tǒng)計學(xué)差異。結(jié)論:(1)應(yīng)用Oxford phase 3代單髁假體,脛骨假體內(nèi)外翻角處于內(nèi)翻5°~外翻5°間時短期臨床效果滿意。(2)脛骨假體內(nèi)外翻角超過外翻5°明顯影響臨床效果。
[Abstract]:Objective: to evaluate the patients with anterior medial knee joint arthritis diagnosed as Anteromedial Osteoartitis undergoing Oxford knee monondylar replacement. Oxford Unicompartmental Knee Arthroplasty. Data and methods: from July 2013 to June 2016, the effect of coronal imaging results of tibial prosthesis on X ray radiographs of the knee joint was observed after OUKA. data and methods: from July 2013 to June 2016. 141 cases of medial compartment osteoarthritis, traumatic arthritis and spontaneous osteonecrosis of knee joint were treated in the second affiliated Hospital of Dalian Medical University. Patients with anterior medial arthritis were selected for this retrospective study. The HSS score of the patients was recorded before operation (P < 0.05). The Hospital for Special Surgery Knee Score. HSS) and range of Knee motion.After operation, the patients were informed by telephone to return to our outpatient clinic to follow up. According to the Oxford knee Joint Operations Manual, two physicians performed X-ray images of patients with UKA after operation. The Radi Ant DICOM Viewer software was used to measure the angle A of the femoral prosthesis and the angle of flexion and extension of the femoral prosthesis. The angle of tibial prosthesis (E) and the posterior inclination angle of tibial plateau are kept in the target range, and the measurement results of the tibial prosthesis's internal and external inversion angle are grouped at 2 擄as an interval. According to the range of results, the tibial prosthesis was divided into 6 groups from -5 擄to 6.35 擄. The mean 鹵standard deviation was used to measure the HSS score and the range of motion of joint motion in 3 擄5 擄and 5 擄7 擄groups. Analysis of variance was used to compare the preoperation and postoperative differences between the abnormal value group and the normal value group. T test was used to compare the difference between the varus group and the valgus group. Results: in this study, there were 129 patients with varus and 172 knees, 22 males with 30 knees and 107 females with 142 knees, including 91 patients with left knee. 81 cases of right knee were followed up for 1 ~ 34 months, with an average follow-up time of 15.7 months. The average ROM was 109.23 擄/ 90 擄/ #number0# 擄/ min before operation and 122.61 擄/ 90 擄/ 90 擄/ 144 擄after operation respectively. The mean preoperative HSS score was 61.17 (39 / 84). The average HSS score was 89.62 (67.3 ~ 100). The postoperative HSS score was significantly improved than that before operation. There was no statistical difference in ROM after operation. The HSS score of 5 擄~ 7 擄group was significantly lower than that of -5 擄~ 5 擄group, and the HSS score of 5 擄~ 7 擄group was significantly lower than that of 5 擄~ 5 擄group. 0.05). There was no statistical difference among the five groups (P 0.05). The comparison between the varus group (89.82 鹵5.02) and the valgus group (89.12 鹵7.10). There was no significant difference in HSS score and ROM between the two groups. Conclusion: 1) Oxford phase 3 single condylar prosthesis is used. The short term clinical effect of tibial prosthesis was satisfactory when the external and internal rotation angle of tibial prosthesis was between 5 擄and 5 擄) the tibial prosthesis had a significant effect on the clinical effect when the angle of external and internal varus of tibial prosthesis exceeded that of valgus 5 擄.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4

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