[1]王晓明,裴卫卫,韩珂,等.胫骨截骨髓内定位和髓外定位对单髁置换术治疗内侧间室膝骨关节炎疗效和安全性的影响[J].中医正骨,2025,37(08):10-14,50.
　WANG Xiaoming,PEI Weiwei,HAN Ke,et al.Impact of intramedullary versus extramedullary referencing in tibial osteotomy on efficacy and safety of unicompartmental knee arthroplasty for treatment of medial compartment knee osteoarthritis:a comparative study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(08):10-14,50.
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胫骨截骨髓内定位和髓外定位对单髁置换术治疗内侧间室膝骨关节炎疗效和安全性的影响()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期数:
2025年08期
页码:
10-14,50
栏目:
临床研究
出版日期:
2025-08-20

文章信息/Info

Title:
Impact of intramedullary versus extramedullary referencing in tibial osteotomy on efficacy and safety of unicompartmental knee arthroplasty for treatment of medial compartment knee osteoarthritis:a comparative study
作者:
王晓明; 裴卫卫; 韩珂; 刘宇
长治医学院附属和平医院,山西 长治 046000
Author(s):
WANG Xiaoming; PEI Weiwei; HAN Ke; LIU Yu
Heping Hospital Affiliated to Changzhi Medical College,Changzhi 046000,Shanxi,China
关键词:
骨关节炎; 膝;  关节成形术; 置换; 膝;  截骨术;  胫骨;  髓内定位;  髓外定位
Keywords:
osteoarthritis; knee;  arthroplasty; replacement; knee;  osteotomy;  tibia;  intramedullary referencing;  extramedullary referencing
摘要:
目的:探讨胫骨截骨髓内定位和髓外定位对单髁置换术治疗内侧间室膝骨关节炎(knee osteoarthritis,KOA)疗效和安全性的影响。方法:回顾性分析60例初次接受单髁置换术的内侧间室KOA患者的病例资料,其中术中胫骨截骨采用髓外定位30例(髓外定位组)、采用髓内定位30例(髓内定位组)。比较2组患者手术时间、术中出血量、引流量、切口长度、住院时间、美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分、Lysholm膝关节评分、髋-膝-踝角(hip-knee-ankle angle,HKA)、胫骨远端外侧角(lateral distal tibial angle,LDTA)、冠状位胫骨假体角(coronal tibia component angle,c-TCA)、c-TCA与90°差值的绝对值、胫骨假体冠状位力线优良率及并发症发生率。结果:①一般结果。2组患者手术时间、术中出血量、引流量、切口长度、住院时间的组间差异均无统计学意义[(120.59±20.31)min,(118.61±19.82)min,t=0.417,P=0.651;(157.32±30.51)mL,(158.59±29.72)mL,t=0.214,P=0.835;(251.37±40.62)mL,(249.85±39.48)mL,t=0.201,P=0.841;(10.21±1.52)cm,(10.09±1.41)cm,t=0.597,P=0.573;(7.58±1.24)d,(7.35±1.12)d,t=0.709,P=0.462]。②疗效评价结果。术后6个月,2组患者HSS膝关节评分和Lysholm膝关节评分均高于术前[HSS膝关节评分:(61.73±14.09)分,(80.45±2.36)分,t=7.177,P=0.000;(61.92±13.87)分,(82.11±1.98)分,t=7.893,P=0.000; Lysholm膝关节评分:(65.27±15.14)分,(81.03±3.02)分,t=4.323,P=0.000;(65.48±14.96)分,(83.75±2.54)分,t=6.595,P=0.000],髓内定位组患者HSS膝关节评分和Lysholm膝关节评分均高于髓外定位组(t=2.951,P=0.005; t=3.775,P=0.000); 术后6个月,2组患者HKA均大于术前(169.73°±13.26°,178.45°±13.21°,t=2.552,P=0.013; 169.28°±11.95°,179.12°±12.98°,t=3.055,P=0.003),组间差异无统计学意义(t=0.112,P=0.911); 术后6个月,2组患者LDTA与术前的差异均无统计学意义,组间差异无统计学意义; 术后6个月,髓内定位组患者c-TCA大于髓外定位组(88.01°±3.12°,89.64°±2.82°,t=2.123,P=0.038),c-TCA与90°差值的绝对值小于髓外定位组(1.33°±0.36°,0.34°±0.10°,t=14.513,P=0.000),胫骨假体冠状位力线优良率高于髓外定位组(χ2=4.043,P=0.044)。③安全性评价结果。2组患者并发症发生率的差异无统计学意义(χ2=0.111,P=0.739)。结论:单髁置换术中胫骨截骨采用髓内定位在恢复膝关节功能、维持良好假体力线方面优于髓外定位,且二者的安全性相当。
Abstract:
Objective:To compare the impact of intramedullary-referencing(IMr)versus extramedullary-referencing(EMr)in tibial osteotomy on efficacy and safety of unicompartmental knee arthroplasty(UKA)for treatment of medial compartment knee osteoarthritis(KOA).Methods:The medical records of 60 patients who underwent primary UKA for medial compartment KOA were retrospectively analyzed.According to the tibial osteotomy technique employed in the UKA,the patients were divided into EMr group and IMr group,30 cases in each group.The outcome measures,including operative time,intraoperative blood loss,drainage volume,incision length,hospital stays,Hospital for Special Surgery(HSS)knee score,Lysholm knee score,hip-knee-ankle angle(HKA),lateral distal tibial angle(LDTA),coronal tibia component angle(c-TCA),absolute deviation of c-TCA from 90°, the excellent/good rate of coronal alignment of the tibial component and complication rates,were compared between the 2 groups.Results:①General outcomes.No significant differences were observed in operative time,intraoperative blood loss,drainage volume,incision length,and hospital stays between the 2 groups(120.59±20.31 vs 118.61±19.82 minutes,t=0.417,P=0.651; 157.32±30.51 vs 158.59±29.72 mL,t=0.214,P=0.835; 251.37±40.62 vs 249.85±39.48 mL,t=0.201,P=0.841; 10.21±1.52 vs 10.09±1.41 cm,t=0.597,P=0.573; 7.58±1.24 vs 7.35±1.12 days,t=0.709,P=0.462).②Efficacy outcomes.At postoperative month 6,both groups showed significantly higher HSS and Lysholm knee scores compared to preoperative values(HSS knee score:61.73±14.09 vs 80.45±2.36 points,t=7.177,P=0.000; 61.92±13.87 vs 82.11±1.98 points,t=7.893,P=0.000; Lysholm knee score:65.27±15.14 vs 81.03±3.02 points,t=4.323,P=0.000; 65.48±14.96 vs 83.75±2.54 points,t=6.595,P=0.000),with higher HSS and Lysholm knee scores observed in the IMr group(t=2.951,P=0.005; t=3.775,P=0.000).Moreover,the HKA was greater in the 2 groups at postoperative month 6 compared to preoperation(169.73±13.26 vs 178.45±13.21 degrees,t=2.552,P=0.013; 169.28±11.95 vs 179.12±12.98 degrees,t=3.055,P=0.003),with no significant difference observed between the 2 groups(t=0.112,P=0.911).However,the LDTA showed no significant changes within or between the 2 groups at postoperative month 6.Besides,the IMr group showed larger c-TCA,smaller absolute deviation of c-TCA from 90°,and higher excellent/good rate of coronal alignment of the tibial component compared to the EMr group(88.01±3.12 vs 89.64±2.82 degrees,t=2.123,P=0.038; 1.33±0.36 vs 0.34±0.10 degrees,t=14.513,P=0.000; χ2=4.043,P=0.044).③Safety outcomes.No significant difference was observed in complication rates between the 2 groups(χ2=0.111,P=0.739).Conclusion:In UKA for treatment of medial compartment KOA,the IMr for tibial osteotomy demonstrates superiority over EMr in restoring knee function and maintaining optimal tibial component alignment,while,the both are comparable in the safety profile.

参考文献/References:

[1] ZHANG B,QIAN H,WU H,et al.Unicompartmental knee arthroplasty versus high tibial osteotomy for medial knee osteoarthritis:a systematic review and meta-analysis[J].J Orthop Surg(Hong Kong),2023,31(1):10225536231162829.
[2] CRAWFORD D A,RUTLEDGE-JUKES H,ALEXANDER J S,et al.15-year follow-up of mobile bearing medial unicompartmental knee arthroplasty[J].J Arthroplasty,2023,38(7):1257-1261.
[3] HARRIS C G,ZIEMBA-DAVIS M,DECKARD E R,et al.Implant position,survivorship,and patient-reported outcomes in manual medial unicompartmental knee arthroplasty[J].J Arthroplasty,2024,39(3):632-637.
[4] GAUDIANI M A,SAMUEL L T,KAMATH A F,et al.Robotic-assisted versus manual unicompartmental knee arthroplasty:contemporary systematic review and meta-analysis of early functional outcomes[J].J Knee Surg,2021,34(10):1048-1056.
[5] ZHANG J,NG N,SCOTT C E H,et al.Robotic arm-assisted versus manual unicompartmental knee arthroplasty:a systematic review and meta-analysis of the MAKO robotic system[J].Bone Joint J,2022,104-B(5):541-548.
[6] BAI H,LIU P,LI H,et al.Comparison of the clinical efficacy of lateral versus medial unicondylar replacement for unicompartmental osteoarthritis of the knee:a meta-analysis[J].J Orthop Surg Res,2025,20(1):12.
[7] PARENTE A,LEGNANI C,BARGAGLIOTTI M,et al.Unicompartmental vs.total knee replacement in patients with failed high tibial osteotomy[J].Arch Orthop Trauma Surg,2022,142(8):2051-2056.
[8] PING H,WEN J,LIU Y,et al.Unicompartmental knee arthroplasty is associated with lower pain levels but inferior range of motion compared with high tibial osteotomy:a systematic overview of meta-analyses[J].J Orthop Surg Res,2022,17(1):425.
[9] THOREAU L,MORCILLO MARFIL D,THIENPONT E.Periprosthetic fractures after medial unicompartmental knee arthroplasty:a narrative review[J].Arch Orthop Trauma Surg,2022,142(8):2039-2048.
[10] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005.
[11] TAY M L,MCGLASHAN S R,MONK A P,et al.Revision indications for medial unicompartmental knee arthroplasty:a systematic review[J].Arch Orthop Trauma Surg,2022,142(2):301-314.
[12] XIA K,MIN L,XIE W,et al.Is unicompartmental knee arthroplasty a better choice than total knee arthroplasty for unicompartmental osteoarthritis?A systematic review and meta-analysis of randomized controlled trials[J].Chin Med J(Engl),2025,138(13):1568-1577.
[13] 中华医学会骨科学分会关节外科学组,中国医师协会骨科医师分会骨关节炎学组,国家老年疾病临床医学研究中心(湘雅医院),等.中国骨关节炎诊疗指南(2021年版)[J].中华骨科杂志,2021,41(18):1291-1314.
[14] HARIRI M,FREYTAG J,KOCH K A,et al.Revision surgery after failure of lateral unicompartmental knee replacement with a mobile-bearing device:a retrospective non-designer case-series[J].Arch Orthop Trauma Surg,2025,145(1):204.
[15] 熊昌军,李朋,张延超,等.胫骨侧个性化髓外定位技术行人工全膝关节置换术后胫骨假体冠状位力线的评价研究[J].中国修复重建外科杂志,2022,36(2):177-182.
[16] 胡天野,林道超.改良型胫骨髓外定位技术应用于Link-Sled假体膝单髁关节置换术的临床疗效[J].中国骨伤,2024,37(11):1120-1125.
[17] 徐成,南少奎,李海峰,等.牛津膝关节单髁置换术髓内定位误差的有限元分析[J].实用骨科杂志,2020,26(12):1079-1082.
[18] MORTAZAVI S M J,VOSOUGHI F.Association of alignment variables,posteromedial tibial cartilage wear and anterior cruciate ligament insufficiency in participants with varus knee osteoarthritis:a cross-sectional study[J].Int Orthop,2022,46(5):1029-1036.

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更新日期/Last Update: 1900-01-01