Oxford膝关节单间室置换术后内翻多因素分析

doi:10.19723/j.issn.1671-167X.2021.02.010

摘要/Abstract

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

及松洁,黄野,王兴山,柳剑,窦勇,姜旭,周一新. Oxford膝关节单间室置换术后内翻多因素分析[J]. 北京大学学报（医学版）, 2021, 53(2): 293-297.

JI Song-jie,HUANG Ye,WANG Xing-shan,LIU Jian,DOU Yong,JIANG Xu,ZHOU Yi-xin. Multivariate analysis of varus after Oxford unicompartmental knee arthroplasty[J]. Journal of Peking University (Health Sciences), 2021, 53(2): 293-297.

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参考文献 23

[1]	Berger RA, Meneghini RM, Jacobs JJ, et al. Results of unicom-partmental knee arthroplasty at a minimum of ten years of follow-up[J]. J Bone Joint Surg Am, 2005,87(5):999-1006. doi: 10.2106/JBJS.C.00568 pmid: 15866962
[2]	Kim MS, Koh IJ, Choi YJ, et al. Differences in patient-reported outcomes between unicompartmental and total knee arthroplasties: a propensity score-matched analysis[J]. J Arthroplasty, 2017,32(5):1453-1459. doi: 10.1016/j.arth.2016.11.034 pmid: 27979407
[3]	van der List JP, Chawla H, Zuiderbaan HA, et al. Patients with isolated lateral osteoarthritis: Unicompartmental or total knee arthroplasty[J]. Knee, 2016,23(6):968-974. doi: 10.1016/j.knee.2016.06.007
[4]	Ko YB, Gujarathi MR, Oh KJ. Outcome of unicompartmental knee arthroplasty: a systematic review of comparative studies between fixed and mobile bearings focusing on complications[J]. Knee Surg Relat Res, 2015,27(3):141-148. doi: 10.5792/ksrr.2015.27.3.141 pmid: 26389066
[5]	Kim KT, Lee S, Kim TW, et al. The influence of postoperative tibiofemoral alignment on the clinical results of unicompartmental knee arthroplasty[J]. Knee Surg Relat Res, 2012,24(2):85-90. doi: 10.5792/ksrr.2012.24.2.85 pmid: 22708108
[6]	Bruni D, Iacono F, Russo A, et al. Minimally invasive unicom-partmental knee replacement: retrospective clinical and radiographic evaluation of 83 patients[J]. Knee Surg Sports Traumatol Arthrosc, 2010,18(6):710-717. doi: 10.1007/s00167-009-0895-9 pmid: 19763541
[7]	Ewald FC. The knee society total knee arthroplasty roentgenographic evaluation and scoring system[J]. Clin Orthop Relat Res, 1989,248(11):9-12.
[8]	Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length[J]. Clin Orthop Relat Res, 1992,274(1):248-264.
[9]	Price AJ, O’Connor JJ, Murray DW, et al. A history of Oxford unicompartmental knee arthroplasty[J]. Orthopedics, 2007,30(Suppl 5):7-10. doi: 10.3928/01477447-20070101-01
[10]	Choy WS, Kim KJ, Lee SK, et al. Mid-term results of oxford medial unicompartmental knee arthroplasty[J]. Clin Orthop Surg, 2011,3(3):178-183. doi: 10.4055/cios.2011.3.3.178 pmid: 21909464
[11]	Mercier N, Wimsey S, Saragaglia D. Long-term clinical results of the Oxford medial unicompartmental knee arthroplasty[J]. Int Orthop, 2010,34(8):1137-1143. doi: 10.1007/s00264-009-0869-z pmid: 19838707
[12]	Kuipers BM, Kollen BJ, Bots PC, et al. Factors associated with reduced early survival in the Oxford phase III medial unicompartment knee replacement[J]. Knee, 2010,17(1), 48-52. doi: 10.1016/j.knee.2009.07.005
[13]	及松洁, 黄野, 王达成, 等. 胫骨高位闭合截骨与开放截骨对胫骨后倾及髌骨高度的影响[J]. 基础医学与临床, 2020,40(10):1394-1398.
[14]	Aleto TJ, Berend ME, Ritter MA, et al. Early failure of unicom-partmental knee arthroplasty leading to revision[J]. J Arthroplasty, 2008,23(2):159-163. doi: 10.1016/j.arth.2007.03.020
[15]	Hernigou P, Deschamps G. Alignment influences wear in the knee after medial unicompartmental arthroplasty[J]. Clin Orthop Relat Res, 2004,423(6):161-165. doi: 10.1097/01.blo.0000128285.90459.12
[16]	Squire MW, Callaghan JJ, Goetz DD, et al. Unicompartmental knee replacement. A minimum 15 year followup study[J]. Clin Orthop Relat Res, 1999,367(10):61-72.
[17]	Cartier P, Sanouiller JL, Grelsamer RP. Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period[J]. J Arthroplasty, 1996,11(7):782-788. doi: 10.1016/s0883-5403(96)80177-x pmid: 8934317
[18]	Tashiro Y, Matsuda S, Okazaki K, et al. The coronal alignment after medial unicompartmental knee arthroplasty can be predicted: usefulness of full-length valgus stress radiography for evaluating correctability[J]. Knee Surg Sports Traumatol Arthrosc, 2014,22(12):3142-3249. doi: 10.1007/s00167-014-3248-2 pmid: 25155051
[19]	Robinson BJ, Rees JL, Price AJ, et al. Dislocation of the bearing of the Oxford lateral unicompartmental arthroplasty. A radiological assessment[J]. J Bone Joint Surg Br, 2002,84(5):653-657. doi: 10.1302/0301-620x.84b5.12950 pmid: 12188479
[20]	Scott CE, Eaton MJ, Nutton RW, et al. Proximal tibial strain in medial unicompartmental knee replacements: a biomechanical study of implant design[J]. Bone Joint J, 2013,95B(10):1339-1347. doi: 10.1302/0301-620X.95B10.31644
[21]	Sawatari T, Tsumura H, Iesaka K, et al. Three-dimensional finite element analysis of unicompartmental knee arthroplasty: the influence of tibial component inclination[J]. J Orthop Res, 2005,23(3):549-554. doi: 10.1016/j.orthres.2004.06.007 pmid: 15885474
[22]	Simpson DJ, Price AJ, Gulati A, et al. Elevated proximal tibial strains following unicompartmental knee replacement: a possible cause of pain[J]. Med Eng Phys, 2009,31(7):752-757. doi: 10.1016/j.medengphy.2009.02.004 pmid: 19278893
[23]	Pandit HG, Campi S, Hamilton TW, et al. Five-year experience of cementless Oxford unicompartmental knee replacement[J]. Knee Surg Sports Traumatol Arthrosc, 2017,25(3):694-702. doi: 10.1007/s00167-015-3879-y pmid: 26611902

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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

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

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)

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