来源：304关节学术

译者：张轶超

整理：骨科在线

Hamilton TW等发表于《Knee Surg Sports Traumatol Arthrosc》杂志的一项研究显示，外侧骨赘不是内侧移动平台假体单髁置换的禁忌证。

外侧骨赘被大家认为表明了外侧间室存在病变，但不清楚这种情况是否可以做内侧单髁置换术。因此研究人员通过影像学分析了一批连续性病例，使用OARSI分级系统将这些病例的骨赘分为0（无骨赘）到3（巨大骨赘）级。这些病例均使用的是骨水泥型移动平台单髁假体，外侧间室保留有完好的软骨，这种情况下即使存在外侧骨赘也并没有被认为是手术禁忌证。评估了出现骨赘的原因，外侧骨赘的大小以及对临床结果和假体生存率的影响。

研究共纳入分析了458膝（392名病人）术前的影像学资料，平均随访10.5年（5.3-16.6年）。有62%的膝有外侧骨赘，其中18%为3级。观察者间的稳定性好(kappa= 0.70)。是否会出现骨赘和外侧骨赘大小与年纪小(p = 0.01)和BMI指数大(p = 0.01)有关；与性别、术前状态、牛津膝关节评分（OKS）、美国膝关节协会评分（AKSS）或功能评分、Tegner运动评分或内侧胫骨病变大小无关。对于骨赘分级为3级的亚族进行分析，发现其与肉眼可见的ACL损伤严重程度有关。各组间10年时在功能方面无差异，15年时在假体生存率和机械性失败率上无差异。对骨赘分级为3级的病例进行分析，发现在10年的功能效果方面和15年的假体生存率上均无明显差异。

作者表示，本研究表明术前应该很好的评估那些外侧间室具有完好软骨但同时具有外侧骨赘的病例，这种情况不会影响内侧单髁置换后的长期功能效果和假体生存率。

原文摘要：

Lateral osteophytes do not represent a contraindication to medial unicompartmental knee arthroplasty: a 15-year follow-up

PURPOSE:

Lateral osteophytes have been reported to be associated with lateral compartment disease and as such it is unclear whether medial unicompartmental knee arthroplasty should be performed if these are present.

METHODS:

Using the OARSI classification system, 0 (no osteophyte) to 3 (large osteophyte), radiographs from a series of cemented meniscal-bearing unicompartmental knee arthroplasty implanted in the setting of full-thickness lateral cartilage where lateral osteophyteswere not considered a contraindication were identified and factors associated with the presence and size of lateral osteophytes, and their impact on clinical outcomes and implant survival were assessed.

RESULTS:

Pre-operative radiographs from 458 knees (392 patients), independently followed up for a mean 10.5 years (range 5.3-16.6), were assessed. Lateral osteophytes were present in 62 % of knees with 18 % scored as Grade 3. Inter-observer reliability was good (kappa = 0.70). The presence and size of lateral osteophytes was associated with younger age at joint replacement (p = 0.01) and increasing BMI (p = 0.01). No association was seen with gender, pre-operative status, assessed using the Oxford Knee Score (OKS), American Knee Society (AKSS) Objective or Functional Score, Tegner activity score, or size of medial tibial lesion. Subgroup analysis of Grade 3 Osteophytes revealed that these were associated with a greater degree of macroscopic ACL damage. At 10 years there was no difference in function (n.s.), and at 15 years no difference in implant survival or mechanism of failure between groups (n.s.). Subgroup analysis of Grade 3 osteophytes found no significant difference in functional outcome at 10 years or implant survival at 15 years.

CONCLUSION:

The presence of lateral osteophytes is not a contraindication to medial meniscal-bearing unicompartmental knee arthroplasty. The clinical relevance of this study is that it highlights the importance of an appropriate pre-operative assessment of the lateral compartment as in the setting of full-thickness cartilage at operation lateral osteophytes do not compromise long-term functional outcome or implant survival.

文献出处：

Hamilton TW, Choudhary R, Jenkins C. Lateral osteophytes do not represent a contraindication to medial unicompartmental knee arthroplasty: a 15-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2017 Mar;25(3):652-659. doi: 10.1007/s00167-016-4313-9. Epub 2016 Sep 8.