【摘要】：研究背景:膝關(guān)節(jié)骨性關(guān)節(jié)炎是一種常見的疾病。骨性關(guān)節(jié)炎是引起膝關(guān)節(jié)疼痛的主要原因之一。膝關(guān)節(jié)骨性關(guān)節(jié)炎曾被認為是老年性退行性疾病。但根據(jù)近年的研究認為,膝關(guān)節(jié)骨性關(guān)節(jié)炎病理形態(tài)上的改變主要為局限性、進行性關(guān)節(jié)軟骨破壞及關(guān)節(jié)邊緣的骨贅形成,而骨贅實際是一種修復(fù)的表現(xiàn)。同時進行截骨術(shù)改變關(guān)節(jié)負重后,骨性關(guān)節(jié)炎則出現(xiàn)修復(fù)現(xiàn)象,所以現(xiàn)在認為膝關(guān)節(jié)骨性關(guān)節(jié)炎并不是退行性病變。膝關(guān)節(jié)單髁置換術(shù)(Unicondylar Knee Arthroplasty,UKA)主要目的是替代膝關(guān)節(jié)脛骨、股骨受破壞的軟骨表面。單髁置換適用于單間室的骨關(guān)節(jié)炎或骨壞死,放射學(xué)檢查提示對側(cè)間隔可以保留且髕骨關(guān)節(jié)未受累或只是輕度退行性病變。目的:本文通過對膝關(guān)節(jié)單髁置換術(shù)(UKA)治療單間室骨關(guān)節(jié)骨性關(guān)節(jié)炎患者的初期臨床觀察,進一步明確UKA的臨床療效。方法:篩選我院2012-2015年內(nèi)側(cè)間室骨關(guān)節(jié)病行膝關(guān)節(jié)患者單髁置換術(shù)30例,術(shù)后1、3、6、12個月,此后每年門診隨訪一次,復(fù)查膝關(guān)節(jié)X線片并記錄療效評分及并發(fā)癥發(fā)生情況�；颊咝g(shù)前、術(shù)后臨床與影像學(xué)資料均被保留。療效評價方法:美國KSS臨床與功能評分(優(yōu):85~100分,良:70~84分,可:60~69分,差:60分)。觀察比較術(shù)前和術(shù)后末次隨訪時所得(Hospital for Special Surgery,HSS)HSS評分、股脛角(FTA)、脛骨平臺后傾角(STA)、最大關(guān)節(jié)活動度之間的差異。療效評估者為非實行手術(shù)醫(yī)師。采用SPSS23.0統(tǒng)計軟件,對手術(shù)前后膝關(guān)節(jié)KSS臨床與HSS評分,計量數(shù)據(jù)采用配對t檢驗,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:本組患者30例通過采用膝關(guān)節(jié)單髁置換術(shù)治療,優(yōu)17例(占56.67%),良11例(占36.67%),可2例(6.66%),差0例�；颊逪SS評分由術(shù)前平均(61.28±4.76)分提高至術(shù)后平均(89.28±3.68)分�；颊咝g(shù)后股脛角(FTA)、脛骨平臺后傾角(STA)較術(shù)前明顯減小,HSS評分及最大關(guān)節(jié)屈伸活動度方面明顯優(yōu)于術(shù)前,與術(shù)前比較明顯改善,差異均有統(tǒng)計學(xué)意義(P0.05)。所有患肢術(shù)后未出現(xiàn)刀口感染、下肢深靜脈血栓形成、肺栓塞、假體周圍骨折等并發(fā)癥。結(jié)論:經(jīng)人工膝關(guān)節(jié)單髁置換術(shù)后HSS評分膝關(guān)節(jié)功能及影像學(xué)評估證實,人工膝關(guān)節(jié)單髁置換術(shù)是一種安全有效的治療單間室骨性膝關(guān)節(jié)炎的方法。
[Abstract]:Background: osteoarthritis of knee joint is a common disease. Osteoarthritis is one of the main causes of knee pain. Osteoarthritis of the knee joint was once considered to be a senile degenerative disease. However, according to recent studies, the pathological changes of osteoarthritis of the knee are mainly limited, progressive destruction of articular cartilage and formation of osteophyte on the edge of the joint, and osteophyte is actually a sign of repair. At the same time osteotomy changes the weight of the joint, osteoarthritis appears repair phenomenon, so now it is considered that knee osteoarthritis is not a degenerative disease. Single condyle replacement (Unicondylar Knee Arthroplasty,UKA) is designed to replace the damaged cartilage surface of the tibia and femur of the knee. Single condyle replacement is suitable for osteoarthritis or osteonecrosis in single chamber. Radiologic examination shows that the contralateral septum can be preserved and patellar joint is not involved or only slightly degenerative. Objective: to investigate the clinical effect of (UKA) in the treatment of osteoarthritis of single compartment osteoarthritis (Osteoarthritis) with single condyle replacement (UKA). Methods: 30 patients with medial interventricular osteoarthropathy underwent single condylar replacement from 2012 to 2015 in our hospital. The patients were followed up every year for 6 months and 12 months after operation. The curative effect score and complications were recorded. Preoperative and postoperative clinical and imaging data were preserved. Methods: clinical and functional score of KSS in USA (excellent: 85 ~ 100, good: 7084, May: 6069, poor: 60). To observe and compare the difference of (Hospital for Special Surgery,HSS) HSS score before and after the last follow-up and the maximum range of joint motion of tibial plateau posterior dip angle (STA), in tibial angle of femur and tibial angle. The curative effect is evaluated by non-performing surgeon. SPSS23.0 statistical software was used to evaluate the clinical and HSS scores of knee joint KSS before and after operation. There was statistical significance in measuring data by pairing t test (P0.05). Results: 30 cases were treated by single condylar replacement of knee joint, 17 cases were excellent (56.67%), 11 cases were good (36.67%), 2 cases were fair (6.66%), and 0 cases were poor. The HSS score of the patients increased from (61.28 鹵4.76) to (89.28 鹵3.68). Postoperative tibial angle (FTA), tibial plateau posterior dip (STA) was significantly lower than the preoperative score and the maximum joint flexion and extension activities were significantly better than before compared with preoperative significantly improved the difference was statistically significant (P0.05). No incision infection, deep vein thrombosis, pulmonary embolism, periprosthetic fracture were found in all the affected limbs. Conclusion: the HSS score of knee joint function and imaging evaluation after single condylar arthroplasty proved that single condylar arthroplasty is a safe and effective method for the treatment of single compartment osteoarthritis.
【學(xué)位授予單位】：青島大學(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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