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单髁置换术的临床现状和生物力学研究进展
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Abstract:
单髁置换术(UKA)、全膝关节置换术(TKA)和胫骨高位截骨(HTO)三种技术在治疗膝关节单间室骨性关节炎方面均有不俗表现。相比较于TKA，UKA有着手术创伤更小、保留原有膝关节运动形态、术后恢复速度更快、对年轻患者友好、经济高效等优势。HTO更适合下肢畸形患者，对于无畸形患者，UKA可以更好降低术后翻修和并发症风险。利用有限元技术对UKA的手术方案、假体评估、术后并发症等方面进行生物力学探究，为临床实践提供参考。
Unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA) and high tibial osteotomy (HTO) are all effective in the treatment of single-compartment osteoarthritis of the knee. Compared with TKA, UKA has the advantages of less surgical trauma, retaining the original knee joint motion pattern, faster postoperative recovery, friendly to young patients, and economical and efficient. HTO is more suitable for patients with lower limb malformations, and UKA can better reduce the risk of postoperative revision and complications for patients without malformations. The biomechanical study of UKA’s surgical plan, prosthesis evaluation and postoperative complications was carried out by using finite element technique to provide reference for clinical practice.
| [1] | Arokoski, J.P.A., Jurvelin, J.S., V？？t？inen, U. and Helminen, H.J. (2000) Normal and Pathological Adaptations of Articular Cartilage to Joint Loading. Scandinavian Journal of Medicine & Science in Sports, 10, 186-198. https://doi.org/10.1034/j.1600-0838.2000.010004186.x |
| [2] | Ranawat, C.S., Flynn Jr., W.F. and Deshmukh, R.G. (1994) Impact of Modern Technique on Long-Term Results of Total Condylar Knee Arthroplasty. Clinical Orthopaedics and Related Research, 309, 131-135. |
| [3] | 王根, 梁杰, 魏国. 内侧间室膝骨性关节炎的手术治疗进展[J]. 沈阳医学院学报, 2018, 20(6): 545-549. |
| [4] | 冯健, 班吉鹤, 高均宏. 单髁置换治疗对膝关节单间室骨关节炎的临床疗效[J]. 浙江创伤外科, 2021, 26(3): 535-536. |
| [5] | Nwachukwu, B.U., McCormick, F.M., Schairer, W.W., Frank, R.M., Provencher, M.T. and Roche, M.W. (2014) Unicompartmental Knee Arthroplasty versus High Tibial Osteotomy: United States Practice Patterns for the Surgical Treatment of Unicompartmental Arthritis. The Journal of Arthroplasty, 29, 1586-1589. https://doi.org/10.1016/j.arth.2014.04.002 |
| [6] | 薛华明, 马童, 文涛. 再议膝关节单髁置换术的适应证[J]. 中华医学杂志, 2024, 104(5): 319-324. |
| [7] | 李程, 张骏, 李强. 全膝关节置换术与单髁置换术治疗膝关节单间室骨关节炎的疗效比较[J]. 中华解剖与临床杂志, 2017, 22(2): 121-126. |
| [8] | 陈墨, 张贤祚, 阿巴斯？麦麦提阿布拉. 观察同一患者单髁与全膝关节置换治疗单间室膝骨关节炎的对比效果[J]. 骨科临床与研究杂志, 2023, 8(6): 329-335. |
| [9] | Knifsund, J., Niinimaki, T., Nurmi, H., Toom, A., Keemu, H., Laaksonen, I., et al. (2021) Functional Results of Total-Knee Arthroplasty versus Medial Unicompartmental Arthroplasty: Two-Year Results of a Randomised, Assessor-Blinded Multicentre Trial. BMJ Open, 11, e046731. https://doi.org/10.1136/bmjopen-2020-046731 |
| [10] | Bagherifard, A., Jabalameli, M., Yahyazadeh, H., et al. (2023) Midterm Outcomes of Unicompartmental Knee Arthroplasty for the Treatment of Knee Medial Compartment Osteoarthritis: A Retrospective Study. The Archives of Bone and Joint Surgery, 11, 326-329. |
| [11] | Crawford, D.A., Berend, K.R. and Thienpont, E. (2020) Unicompartmental Knee Arthroplasty. Orthopedic Clinics of North America, 51, 147-159. https://doi.org/10.1016/j.ocl.2019.11.010 |
| [12] | 王兴山, 柳剑, 蒋毅. 应用Oxford单髁置换术治疗年轻膝内侧单间室骨关节炎患者的早期疗效[J]. 骨科临床与研究杂志, 2020, 5(1): 32-36. |
| [13] | Greco, N.J., Lombardi, A.V., Price, A.J., Berend, M.E. and Berend, K.R. (2018) Medial Mobile-Bearing Unicompartmental Knee Arthroplasty in Young Patients Aged Less than or Equal to 50 Years. The Journal of Arthroplasty, 33, 2435-2439. https://doi.org/10.1016/j.arth.2018.03.069 |
| [14] | Soohoo, N.F., Sharifi, H., Kominski, G. and Lieberman, J.R. (2006) Cost-Effectiveness Analysis of Unicompartmental Knee Arthroplasty as an Alternative to Total Knee Arthroplasty for Unicompartmental Osteoarthritis. The Journal of Bone and Joint Surgery-American, 88, 1975-1982. https://doi.org/10.2106/00004623-200609000-00011 |
| [15] | 阎峻, 许建中. 胫骨高位截骨治疗内侧间室骨性关节炎[J]. 中原医刊, 2007, 34(10): 61-62. |
| [16] | 恽常军, 钱文杰, 王岩峰. 胫骨高位截骨联合关节镜手术治疗膝关节内侧骨关节炎[J]. 中华创伤骨科杂志, 2020, 22(9): 808-812. |
| [17] | Lobenhoffer, P. and Agneskirchner, J.D. (2014) Umstellungsosteotomie vs. unikondyl？re Prothese bei Gonarthrose. Der Orthop？de, 43, 923-929. https://doi.org/10.1007/s00132-014-3011-x |
| [18] | Dettoni, F., Bonasia, D.E., Castoldi, F., et al. (2010) High Tibial Osteotomy versus Unicompartmental Knee Arthroplasty for Medial Compartment Arthrosis of the Knee: A Review of the Literature. Iowa Orthopedic Journal, 30, 131-140. |
| [19] | 卫鹏斌, 高虎方, 朱广伟, 等. 胫骨上端高位截骨术与单髁置换术治疗膝关节单侧骨性关节炎的效果比较[J]. 临床医学, 2024, 44(5): 16-19. |
| [20] | Stukenborg-Colsman, C., Wirth, C.J., Lazovic, D. and Wefer, A. (2001) High Tibial Osteotomy versus Unicompartmental Joint Replacement in Unicompartmental Knee Joint Osteoarthritis. The Knee, 8, 187-194. https://doi.org/10.1016/S0968-0160(01)00097-7 |
| [21] | Zhang, Q.D., Guo, W.S., Liu, Z.H., et al. (2009) Meta-Analysis of Unicompartmental Knee Arthroplasty versus High Tibial Osteotomy in the Treatment of Unicompartmental Knee Osteoarthritis. Chinese Medical Journal, 89, 2768-2772. |
| [22] | Besier, T.F., Gold, G.E., Beaupré, G.S. and Delp, S.L. (2005) A Modeling Framework to Estimate Patellofemoral Joint Cartilage Stress in vivo. Medicine & Science in Sports & Exercise, 37, 1924-1930. https://doi.org/10.1249/01.mss.0000176686.18683.64 |
| [23] | Hernigou, P. and Deschamps, G. (2004) Posterior Slope of the Tibial Implant and the Outcome of Unicompartmental Knee Arthroplasty. The Journal of Bone & Joint Surgery, 86, 506-511. https://doi.org/10.2106/00004623-200403000-00007 |
| [24] | Nie, Y., Yu, Q. and Shen, B. (2021) Impact of Tibial Component Coronal Alignment on Knee Joint Biomechanics Following Fixed-Bearing Unicompartmental Knee Arthroplasty: A Finite Element Analysis. Orthopaedic Surgery, 13, 1423-1429. https://doi.org/10.1111/os.12927 |
| [25] | Kang, K., Park, J., Koh, Y., Shin, J. and Park, K.K. (2019) Biomechanical Effects of Posterior Tibial Slope on Unicompartmental Knee Arthroplasty Using Finite Element Analysis. Bio-Medical Materials and Engineering, 30, 133-144. https://doi.org/10.3233/bme-191039 |
| [26] | Ma, P., Muheremu, A., Zhang, S., Zheng, Q., Wang, W. and Jiang, K. (2022) Biomechanical Effects of Fixed-Bearing Femoral Prostheses with Different Coronal Positions in Medial Unicompartmental Knee Arthroplasty. Journal of Orthopaedic Surgery and Research, 17, Article No. 150. https://doi.org/10.1186/s13018-022-03037-0 |
| [27] | Kang, K., Son, J., Koh, Y., Kwon, O., Kwon, S.K., Lee, Y.J., et al. (2018) Effect of Femoral Component Position on Biomechanical Outcomes of Unicompartmental Knee Arthroplasty. The Knee, 25, 491-498. https://doi.org/10.1016/j.knee.2018.03.003 |
| [28] | Yang, Y., Guo, Y., Wang, C., Zhang, X., Zhang, K. and Ji, B. (2024) Finite Element Analysis of Sagittal Angles of Unicompartmental Knee Arthroplasty. Clinical Biomechanics, 114, Article 106232. https://doi.org/10.1016/j.clinbiomech.2024.106232 |
| [29] | Zhang, Z., Qi, Y., Wei, B., Bao, H. and Xu, Y. (2023) Application Strategy of Finite Element Analysis in Artificial Knee Arthroplasty. Frontiers in Bioengineering and Biotechnology, 11, Article 1127289. https://doi.org/10.3389/fbioe.2023.1127289 |
| [30] | Patil, S., Bunn, A., Bugbee, W.D., Colwell, C.W. and D’Lima, D.D. (2015) Patient-Specific Implants with Custom Cutting Blocks Better Approximate Natural Knee Kinematics than Standard TKA without Custom Cutting Blocks. The Knee, 22, 624-629. https://doi.org/10.1016/j.knee.2015.08.002 |
| [31] | Kang, K., Son, J., Suh, D., Kwon, S.K., Kwon, O. and Koh, Y. (2018) Patient-Specific Medial Unicompartmental Knee Arthroplasty Has a Greater Protective Effect on Articular Cartilage in the Lateral Compartment. Bone & Joint Research, 7, 20-27. https://doi.org/10.1302/2046-3758.71.bjr-2017-0115.r2 |
| [32] | Koh, Y., Park, K., Lee, H. and Kang, K. (2019) Influence of Tibiofemoral Congruency Design on the Wear of Patient-Specific Unicompartmental Knee Arthroplasty Using Finite Element Analysis. Bone & Joint Research, 8, 156-164. https://doi.org/10.1302/2046-3758.83.bjr-2018-0193.r1 |
| [33] | Asada, S., Inoue, S., Tsukamoto, I., Mori, S. and Akagi, M. (2019) Obliquity of Tibial Component After Unicompartmental Knee Arthroplasty. The Knee, 26, 410-415. https://doi.org/10.1016/j.knee.2018.12.013 |
| [34] | Crawford, D.A., Berend, K.R. and Lombardi, A.V. (2018) Management of the Failed Medial Unicompartmental Knee Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons, 26, e426-e433. https://doi.org/10.5435/jaaos-d-17-00107 |
| [35] | Chui, E.C., Lau, L.C., Kwok, C.K., Ng, J.P., Hung, Y., Yung, P.S., et al. (2021) Tibial Cutting Guide (Resector) Holding Pins Position and Subsequent Risks of Periprosthetic Fracture in Unicompartmental Knee Arthroplasty: A Finite Element Analysis Study. Journal of Orthopaedic Surgery and Research, 16, Article No. 205. https://doi.org/10.1186/s13018-021-02308-6 |
| [36] | Hou, Z., Lyu, X. and Zhang, J. (2023) Effect of Pin Holes Location of Unicompartmental Knee Arthroplasty on Postoperative Tibial Plateau Mechanical Properties. Chinese Journal of Medical Instrumentation, 47, 502-506. |
| [37] | Sasatani, K., Majima, T., Murase, K., Takeuchi, N., Matsumoto, T., Oshima, Y., et al. (2020) Three-Dimensional Finite Analysis of the Optimal Alignment of the Tibial Implant in Unicompartmental Knee Arthroplasty. Journal of Nippon Medical School, 87, 60-65. https://doi.org/10.1272/jnms.jnms.2020_87-202 |
| [38] | Sano, M., Oshima, Y., Murase, K., Sasatani, K. and Takai, S. (2020) Finite-Element Analysis of Stress on the Proximal Tibia after Unicompartmental Knee Arthroplasty. Journal of Nippon Medical School, 87, 260-267. https://doi.org/10.1272/jnms.jnms.2020_87-504 |
| [39] | Zhang, G., Smith, B.P., Plate, J.F., Casanova, R., Hsu, F.-C., Li, J., et al. (2016) A Systematic Approach to Predicting the Risk of Unicompartmental Knee Arthroplasty Revision. Osteoarthritis and Cartilage, 24, 991-999. https://doi.org/10.1016/j.joca.2016.01.004 |
| [40] | Iriberri, I. and Aragón, J.F. (2014) Alignment of the Tibial Component of the Unicompartmental Knee Arthroplasty, Assessed in the Axial View by CT Scan: Does It Influence the Outcome? The Knee, 21, 1269-1274. https://doi.org/10.1016/j.knee.2014.06.008 |
