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北京大学学报（医学版） ›› 2021, Vol. 53 ›› Issue (2): 293-297. doi: 10.19723/j.issn.1671-167X.2021.02.010

• 论著 • 上一篇    下一篇

Oxford膝关节单间室置换术后内翻多因素分析

及松洁,黄野,王兴山,柳剑,窦勇,姜旭,周一新()   

  1. 北京积水潭医院矫形骨科,北京 100035
  • 收稿日期:2019-12-31 出版日期:2021-04-18 发布日期:2021-04-21
  • 通讯作者: 周一新 E-mail:13683514672@139.com
  • 基金资助:
    北京积水潭医院青年人才培养学科新星计划项目(XKXX2018)

Multivariate analysis of varus after Oxford unicompartmental knee arthroplasty

JI Song-jie,HUANG Ye,WANG Xing-shan,LIU Jian,DOU Yong,JIANG Xu,ZHOU Yi-xin()   

  1. Department of Adult Joint Reconstruction Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
  • Received:2019-12-31 Online:2021-04-18 Published:2021-04-21
  • Contact: Yi-xin ZHOU E-mail:13683514672@139.com
  • Supported by:
    Beijing Jishuitan Hosptial Nova Program(XKXX2018)

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摘要：

目的: 分析使用Oxford膝关节单间室假体置换术后出现内翻的术前影响因素。方法: 选择北京积水潭医院矫形骨科2018年1月至2019年12月施行的660例(767膝)Oxford单间室置换患者的病例资料进行回顾性分析。根据术后力线X线片分为内翻组(Noyes≥3°)和正常组(Noyes<3°)两组。比较两组患者性别、年龄、体重指数(body mass index,BMI)、膝关节活动度(range of motion,ROM)、术前屈曲畸形(flexion deformity,FD)、膝关节疼痛评分(American Knee Society pain score,AKS)和功能评分(American Knee Society function score,AKS function), 测量术前Noyes角、股骨远端外侧角(lateral distal femoral angle,LDFA)、胫骨近端内侧角(medial proximal tibial angle,MPTA)、关节线相交角(joint line converge angle,JLCA), 并对以上术前因素进行分析。结果: 患者的性别、术侧、年龄、BMI、术前ROM、术前膝关节疼痛评分和功能评分不是术后力线内翻的危险因素(P>0.05)。术后内翻的影响因素依次为MPTA<84°(P=0.018,OR=3.712,95%CI:1.250~11.027), 术前Noyes>5°(P=0.000,OR=3.105,95%CI:1.835~5.254),术前FD>5°(P=0.001,OR=1.976,95%CI:1.326~3.234)。术前LDFA(P=0.146)和术前JLCA(P=0.709)对术后力线都没有表现出统计学意义的影响。结论: 术前内翻较重的患者,尤其内翻畸形主要来自胫骨侧的患者,以及术前有屈曲畸形的患者更容易出现Oxford单间室置换术后力线内翻。

关键词: 单髁置换, 下肢力线, 活动平台, 关节成形术, X线片

Abstract:

Objective: To analyze the preoperative influencing factors of varus after Oxford unicompartmental knee arthroplasty. Methods: A total of 660 patients (767 knees) undergoing Oxford unicompartmental knee arthroplasty in adult joint reconstruction surgery department of Beijing Jishuitan Hospital from January 2018 to December 2019 were retrospectively analyzed. Inclusive criteria: diagnosis was osteoarthritis, single compartment lesions in the medial side of the knee; preoperative flexion deformity was less than 10°, active range of motion was greater than 90°; preoperative X-ray full-length images of both lower limbs showed less than 15° varus (Noyes method); anterior cruciate ligament was well functioned, The cartilage of lateral compartment of knee joint was intact. Exclusion criteria: combined with other inflammatory arthropathy; combined with extraarticular deformity; previous knee surgery history. The average age of the patients was (64.4±8.1) years, including 153 males and 497 females. The degree of post-operative varus was measured with Noyes method. The total patients were divided into varus group (Noyes≥3 °) and normal group (Noyes<3 °). Gender, age, body mass index (BMI), range of motion (ROM), preoperative flexion deformity (FD), American Knee Society pain score (AKS) and American Knee Society function score (AKS function) were recorded. The standard anteroposterior and lateral X-ray films of knee joint and full-length lower extremity kinematic line films were taken by Sonialvision Safine Ⅱ (Shimadzu, Japan) multi-function digital tomography system. The image was measured by picture archiving and communication system (PACS). The following angles were measured preoperative Noyes angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and joint line converge angle (JLCA) were measured and analyzed. Results: Gender(P=0.346), operative side (P=0.619), age (P=0.746), BMI (P=0.142), preoperative ROM (P=0.102), preoperative knee pain score (P=0.131) and functional score (P=0.098) were not risk factors for postoperative varus. The influencing factors of postoperative varus were preoperative MPTA<84 ° (P= 0.018, OR= 3.712, 95%CI: 1.250-11.027), preoperative Noyes > 5°(P=0.000, OR= 3.105, 95%CI: 1.835-5.254), preoperative FD > 5° (P= 0.001, OR=1.976, 95%CI: 1.326-3.234). Pre-operative LDFA (P=0.146) and preoperative JLCA (P= 0.709) had no significant effect on postoperative kinematic line. Conclusion: Patients with severe preoperative varus, especially those with varus deformity mainly from the tibial side, and those with preoperative flexion deformity are more prone to get varus lower extremity kinematic line after Oxford unicompartmental knee arthroplasty.

Key words: Unicompartmental knee arthroplasty, Alignment, Mobile-bearing, Arthroplasty, X-ray film

中图分类号: 

  • R687.4

表1

患者一般情况和术前评分"

Items Normal Varus χ2/Z P
Knees 669 98 - -
Gender, male/female 173/496 22/76 0.886 0.346
Side, left/right 332/337 46/52 0.247 0.619
Age/years 63.9±7.2 65.4±9.2 -0.324 0.746
BMI/(kg/m2), $\bar{x} \pm s$ 26.2±3.1 26.3±3.4 -1.467 0.142
AKS, $\bar{x} \pm s$ 57.4±14.4 55.5±14.4 -1.511 0.131
AKS function, $\bar{x} \pm s$ 65.6±11.4 63.7±11.7 -1.656 0.098
ROM/(°), $\bar{x} \pm s$ 101.7±19.1 97.7±17.3 -1.636 0.102
FD/(°), $\bar{x} \pm s$ 3.8±3.4 5.4±3.1 -4.373 <0.001

图1

在双下肢全长及膝关节正位X线片上测量"

表2

术后力线内翻组和力线正常组病例的术前测量结果($\bar{x} \pm s$)"

Items Normal(n=669) Varus(n=98) Z P
Noyes 3.4±1.4 4.7±2.2 -5.882 <0.001
MPTA 85.9±1.5 84.9±1.6 -5.673 <0.001
LDFA 88.1±0.9 88.3±1.1 -1.293 0.196
JLCA 1.3±1.0 1.4±1.1 -0.889 0.374

表3

多因素分析的自变量设定"

Dependent variable Normal Varus
FD>5° Yes 233 (34.8) 50 (51.0)
No 436 (65.2) 48 (48.9)
Noyes>5° Yes 88 (13.2) 27 (27.6)
No 581 (86.7) 71 (72.4)
LDFA>90° Yes 11 (1.6) 7 (7.1)
No 658 (98.4) 91 (92.9)
MPTA<84° Yes 16 (2.4) 25 (25.6)
No 653 (97.6) 73 (74.4)
JLCA>2° Yes 96 (14.3) 14 (14.3)
No 573 (85.7) 88 (89.8)

表4

膝关节单间室置换术后内翻的术前危险因素的非条件Logistic回归分析"

Parameter B Wald OR 95%CI P
FD>5° 0.728 10.258 1.976 1.326-3.234 <0.001
Noyes>5° 1.133 17.833 3.105 1.835-5.254 <0.001
LDFA>90° 0.774 2.144 2.168 0.738-6.156 0.146
MPTA<84° 1.312 5.575 3.712 1.250-11.027 0.018
JLCA>2° -0.122 3.383 0.885 0.466-1.680 0.709
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