【摘要】 目的本研究对因膝关节前内侧关节炎进行Oxford单髁置换的中国患者前瞻性收集数据和术中观察髌股关节情况,并探讨这一结论的正确性。方法研究包括本单位从2009年8月至2011年5月连续进行的50例(45例患者)单髁置换病例。术前记录膝关节疼痛的部位,放射学检查发现的髌股关节退变用Ahlback系统分级。对于术中观察到的股骨滑车软骨磨损情况用Weidow 5级分级系统记录,其将软骨状况从无磨损到全层磨损分为0至Ⅳ级。在术后1年随访是用Hospital for Special Surgery膝关节评分系统和自我满意度评分对临床疗效进行评定。结果术前放射学检查发现17膝(34%)存在髌股关节退变。术中观察发现27膝(54%)存在股骨滑车软骨面磨损,其中19例(38%)位于滑车沟偏内侧,6例(12%)位于滑车沟中央,1例(2%)位于滑车沟偏外侧,共有3例(6%)全层软骨磨损,2例(4%)位于滑车沟偏内侧,1例(2%)位于滑车沟偏外侧。不论是放射学发现的髌股关节退变还是术中发现软骨磨损病例与髌股关节相对正常病例相比,临床疗效没有显著性差异。结论术前放射学发现的髌股关节退变和术中发现髌股关节软骨磨损均不能作为Oxford内侧单髁置换的反指征。因外侧髌股关节退变的相关数据较少,对这类患者选择单髁置换时应慎重。更多还原

【Abstract】 Objective To investigate the influence of patellofemoral joint degeneration on the Oxford medial unicompartmental knee replacement in Chinese patients with anteromedial osteoarthritis.Methods There were 50 consecutive knees( 45 patients) in this prospective study.All the operations were performed between August 2009 and May 2011.The site of pre-operative pain in the knee was recorded and the degenerative change of the patellofemoral joint was defined by the Ahlback systems according to radiographic results.A Weidow five-point grading system was also used to classify the degeneration of the patellofemoral joint from none to full-thickness cartilage loss according to intra-operative observation.Outcome was evaluated in the one-year follow-up by Hospital for Special Surgery knee score and total satisfaction score.Results Degenerative changes of the patellofemoral joint were seen in 17knees( 34%) on the axial patella radiographs.Cartilage loss was observed on the trochlear surface in 27knees( 54%),on the medial trochlear in 19 knees( 38%),on the central trochlear in nine knees( 18%) and on the lateral trochlear in one knee( 2%).Full-thickness cartilage loss was observed in three knees( 6%) :two were on the medial trochlear and one was on the lateral trochlear.There was no significant difference in the clinical outcomes of the patellofemoral joints between radiographic-degeneration or trochlear-cartilage-loss patients and the normal or near-normal patients.Conclusion Neither radiological degeneration nor cartilage loss of the patellofemoral joint should be considered as contraindication for Oxford medial unicompartmental knee replacement.As for lateral patellofemoral degeneration,there is not enough data and it should be treated with great caution.更多还原