本文關(guān)鍵詞： 髕股關(guān)節(jié)退變 膝前痛 膝關(guān)節(jié)單髁置換術(shù)(UKA)　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】：背景:隨著人類生活環(huán)境及生活習(xí)慣的不斷改變,中老年人膝關(guān)節(jié)骨性關(guān)節(jié)炎的發(fā)病率僅次于糖尿病高血壓病等中老年人常見疾病,然而超過(guò)半數(shù)的膝關(guān)節(jié)骨性關(guān)節(jié)炎的病變部位大部分局限于膝關(guān)節(jié)內(nèi)側(cè)間室。目前膝關(guān)節(jié)單髁置換術(shù)(UKA Unicompartmental Knee Arthroplasty)被認(rèn)為是治療中老年患者膝關(guān)節(jié)骨性關(guān)節(jié)炎內(nèi)側(cè)間室病變的最好選擇,特別是微創(chuàng)單髁置換術(shù)。因?yàn)閁KA與全膝關(guān)節(jié)置換術(shù)(TKA Total Knee Arthroplasty)相比,具有創(chuàng)傷小、死亡率低及并發(fā)癥發(fā)生率低等優(yōu)點(diǎn),更能減少患者的痛苦,更接近膝關(guān)節(jié)的生理解剖結(jié)構(gòu)[1-4]。然而UKA的手術(shù)適應(yīng)癥目前還不是很明確,其中很多研究認(rèn)為髕股關(guān)節(jié)炎應(yīng)該是UKA的禁忌證,也有很多學(xué)者認(rèn)為這個(gè)觀點(diǎn)是錯(cuò)誤的。曾經(jīng)有研究稱髕股關(guān)節(jié)炎是UKA翻修最常見的原因[5-8]。另外,也有一些學(xué)者研究表明術(shù)前髕股關(guān)節(jié)是否存在退變并不影響UKA術(shù)后療效,所以,他們認(rèn)為是行UKA治療時(shí),特別是采用活動(dòng)平臺(tái)的假體,可以不考慮髕股關(guān)節(jié)的退變情況[9-11]。目的:研究膝前痛和髕股關(guān)節(jié)退變對(duì)治療膝關(guān)節(jié)內(nèi)側(cè)關(guān)節(jié)炎行膝關(guān)節(jié)內(nèi)側(cè)間室單髁置換術(shù)(UKA)的術(shù)后治療效果的影響。方法:回顧性分析2013年7月至2015年7月期間,大連醫(yī)科大學(xué)附屬第二醫(yī)院關(guān)節(jié)外科為治療膝關(guān)節(jié)內(nèi)側(cè)膝關(guān)節(jié)炎行膝關(guān)節(jié)內(nèi)側(cè)單髁置換手術(shù)(UKA)的86例膝(83個(gè)患者)。其中男性患膝15例,女性患膝71例;年齡42~81歲,平均66.3歲�；颊唧w重指數(shù)(BMI)23~27 kg/m2,平均25.3 kg/m2。根據(jù)患者術(shù)前是否存在膝前疼痛,將選取患者分為膝前疼痛組和無(wú)膝前疼痛組。術(shù)前采用Altman分級(jí)和Ahlback評(píng)分分別對(duì)這86例膝關(guān)節(jié)術(shù)前髕股關(guān)節(jié)影像學(xué)退變情況進(jìn)行評(píng)估,將患膝分為內(nèi)側(cè)正常組、內(nèi)側(cè)退變組、外側(cè)正常組、外側(cè)退變組。采用牛津膝關(guān)節(jié)評(píng)分(OKS評(píng)分)、美國(guó)膝關(guān)節(jié)學(xué)會(huì)評(píng)分(AKS評(píng)分)對(duì)術(shù)前和術(shù)后膝關(guān)節(jié)疼痛情況及功能進(jìn)行評(píng)分。采用SPSS軟件對(duì)術(shù)前與術(shù)后末次隨訪時(shí)膝關(guān)節(jié)AKS、OKS得分進(jìn)行獨(dú)立樣本t檢驗(yàn)分析,用均數(shù)±標(biāo)準(zhǔn)差(喁±s)表示。結(jié)果:所有本研究選取的患者均獲得了完整的隨訪,隨訪時(shí)間為12—24個(gè)月,平均15.6個(gè)月。所有選取的患者術(shù)后均無(wú)感染、聚乙烯襯墊脫位、假體位置不良或松動(dòng)、假體周圍骨折等并發(fā)癥。所有選取的患者術(shù)后末次隨訪時(shí)OKS、AKS得分較有術(shù)前均顯著改善(P0.01)。將選取的患者進(jìn)行分組,膝前疼痛組42例,無(wú)膝前痛組44例,兩組術(shù)前OKS、AKS得分分別進(jìn)行比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);兩組末次隨訪時(shí)OKS、AKS得分分別進(jìn)行比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。根據(jù)Ahlback和Altman評(píng)估髕股關(guān)節(jié)退變的情況,將所選患者進(jìn)行分組。內(nèi)側(cè)髕股關(guān)節(jié)正常53例,內(nèi)側(cè)髕股關(guān)節(jié)退變33例;外側(cè)髕股關(guān)節(jié)正常74例,外側(cè)髕股關(guān)節(jié)退變12例(根據(jù)Altman評(píng)分)。內(nèi)側(cè)髕股關(guān)節(jié)正常77例,內(nèi)側(cè)髕股關(guān)節(jié)退變9例;外側(cè)髕股關(guān)節(jié)正常80例,外側(cè)髕股關(guān)節(jié)退變6例(根據(jù)Ahlback分級(jí))。根據(jù)Ahlback和Altman評(píng)估,患者術(shù)前無(wú)論是否存在髕股關(guān)節(jié)退變,末次隨訪時(shí)OKS、AKS得分較術(shù)前均有顯著改善(P0.01),有無(wú)內(nèi)側(cè)髕股關(guān)節(jié)退變表現(xiàn)的兩組患者術(shù)前OKS、AKS得分之間進(jìn)行比較,術(shù)后末次隨訪OKS、AKS得分之間進(jìn)行比較,結(jié)果顯示差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。根據(jù)Ahlback分級(jí),有無(wú)髕股關(guān)節(jié)外側(cè)退變表現(xiàn)的兩組患者術(shù)前OKS、AKS得分之間進(jìn)行比較,術(shù)后末次隨訪時(shí)OKS、AKS得分之間進(jìn)行比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義;根據(jù)Altman評(píng)分,有無(wú)外側(cè)髕股關(guān)節(jié)退變的兩組患者術(shù)前OKS、AKS得分之間進(jìn)行比較,差異無(wú)統(tǒng)計(jì)學(xué)意義;術(shù)后末次隨訪時(shí),兩組患者的OKS得分之間進(jìn)行比較,差異也無(wú)統(tǒng)計(jì)學(xué)意義,但是末次隨訪時(shí)外側(cè)髕股關(guān)節(jié)退變患者的AKS得分要低于無(wú)外側(cè)髕股關(guān)節(jié)退變患者的AKS得分,而且差異有統(tǒng)計(jì)學(xué)意義(-2.47,-2.06 P=0.020.05)。結(jié)論:膝前痛和髕股關(guān)節(jié)內(nèi)側(cè)退變不影響膝關(guān)節(jié)內(nèi)側(cè)間室單髁置換術(shù)的治療效果,而髕股關(guān)節(jié)外側(cè)退變的患者行膝關(guān)節(jié)內(nèi)側(cè)間室單髁置換術(shù)的治療效果要比髕股關(guān)節(jié)外側(cè)正常的患者的治療效果差。
[Abstract]:Background: with the continuous change of the human living environment and living habits, the incidence of elderly knee osteoarthritis rate after common disease hypertension and diabetes in the elderly, but more than half of the lesion of knee osteoarthritis was largely confined to the medial knee compartment. The unicompartmental knee arthroplasty (UKA Unicompartmental Knee Arthroplasty) is considered to be the best choice in the treatment of elderly patients with knee osteoarthritis of the medial compartment lesions, especially minimally invasive unicompartmental arthroplasty. Because the UKA and total knee arthroplasty (TKA Total Knee Arthroplasty) compared with small trauma, low mortality rate and low complication rate, better to reduce the suffering of patients, closer to the physiological knee anatomy [1-4]. however UKA indications for surgery is still not very clear, many of them think of patellofemoral off Arthritis should be a contraindication to UKA, there are many scholars believe that this view is wrong. Once called patellofemoral arthritis is the most common cause of [5-8]. UKA revision in addition, there are also some scholars study shows that preoperative patellofemoral degeneration does not affect the existence of UKA postoperative curative effect, so they think is UKA at the time of treatment, especially the prosthesis of the movable platform, can not consider the patellofemoral degeneration of [9-11]. Objective: To study the anterior knee pain and degeneration of the patellofemoral joint treatment of medial knee arthritis of knee joint medial unicompartmental arthroplasty (UKA) effect after surgery. Methods: a retrospective analysis of July 2013 to July 2015, joint surgery, Second Affiliated Hospital of Dalian Medical University for treatment of medial knee osteoarthritis knee joint medial unicompartmental arthroplasty (UKA) of 86 cases of knee (83 patients). The 15 men suffering from knee Cases of female knee in 71 cases; age 42~81 years old, average 66.3 years old. The body mass index (BMI) of 23~27 kg/m2, an average of 25.3 kg/m2. according to whether patients with anterior knee pain, the selected patients were divided into anterior knee pain group and anterior knee pain score group. Of the 86 cases of knee joint surgery the patellofemoral joint degeneration were evaluated by Altman grading and Ahlback before operation, will be divided into medial knee medial degeneration group, normal group, normal group, lateral, lateral degeneration group. Using the Oxford knee score (OKS score), American Knee Society score (AKS score) score of joint function and knee pain before and after surgery. The preoperative and final follow-up after operation of knee joint AKS by SPSS software, the OKS score was analyzed by independent sample t test, standard deviation (Yong + s). Results: all the study selected the patients got complete follow-up follow-up. The time is 12 to 24 months, average 15.6 months. All the patients had no infection, dislocation of the polyethylene liner, implant malposition or loosening, periprosthetic fracture and other complications. At the end of the follow-up of all selected patients after OKS, AKS score before surgery were significantly improved (P0.01). The selected patients were divided into two groups, anterior knee pain group of 42 patients without anterior knee pain group 44 cases, two groups of preoperative OKS, AKS scores were compared, there were no significant differences between the two groups (P0.05); at the end of the follow-up OKS, AKS scores were compared, the differences were not statistically significant (P0.05 Ahlback and Altman). According to the assessment of patellofemoral joint degeneration, the selected patients were divided into two groups. The medial patellofemoral joint was normal in 53 cases, 33 cases of medial patellofemoral degeneration; lateral patellofemoral joint was normal in 74 cases, 12 cases of patellofemoral joint degeneration (according to the Altman score). The medial patellofemoral joint in 77 cases of normal. 9 cases of lateral patellofemoral degeneration; lateral patellofemoral joint was normal in 80 cases, 6 cases of patellofemoral joint degeneration (according to the Ahlback classification). According to Ahlback and Altman in patients with preoperative assessment, regardless of the existence of patellofemoral degeneration, at the end of the follow-up OKS, AKS scores were significantly improved compared with the preoperative (P0.01), there are no patients the two group OKS medial patellofemoral degeneration performance, compare the AKS score, postoperative follow-up were compared between OKS, AKS scores, results showed that there were no significant differences (P0.05). According to Ahlback classification, there are two groups of patients with OKS before the lateral patellofemoral joint degeneration, compared to AKS the score between the last follow-up after operation were compared between OKS, AKS score, there were no significant differences; according to the Altman score, there are two groups of patients with OKS before patellofemoral joint degeneration, AKS scores were compared, the difference was not statistically significant ; at the end of the follow-up after operation, were compared between the two groups of patients with OKS score, there was no significant difference, but at the end of the follow-up lateral patellofemoral joint degeneration in patients with AKS score lower than the non lateral patellofemoral degeneration in patients with AKS score, and the difference was statistically significant (-2.47, -2.06, P=0.020.05). Conclusion: the knee the pain and the medial patellofemoral degeneration does not affect the knee joint medial compartment unicompartmental arthroplasty treatment, while the patients of knee joint medial patellofemoral degenerative lateral compartment unicompartment arthroplasty in the treatment of patellofemoral lateral effect than normal in patients with poor therapeutic effect.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4

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