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ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 21  |  Page : 2544-2550

Clinical Characteristics and Treatment of Spontaneous Osteonecrosis of Medial Tibial Plateau: A Retrospective Case Study


1 Department of Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China
2 Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, China

Correspondence Address:
Dr. Wei-Ming Yang
Department of Orthopaedics, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.244113

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Background: In a small proportion of cases, spontaneous osteonecrosis of the knee (SONK) involves the medial tibial plateau (MT). Here, we introduced the clinical characteristics of spontaneous osteonecrosis of the MT and unicompartmental knee arthroplasty (UKA) as the favorable treatment for this situation based on a retrospective case study. Methods: Patients with spontaneous osteonecrosis of the MT, confirmed by magnetic resonance imaging (MRI) at Guangdong Provincial Hospital of Chinese Medicine (China) from March 2015 to June 2016, were included as a case serial and analyzed retrospectively. All patients underwent Oxford Medial UKA. The characteristics of their lesions, corresponding treatment, and results of follow-up were presented. The lesion scores and grade were determined according to the criteria of Ficat and Arlet. Results: In total, 22 patients (5 men, 17 women; mean age, 64.1 years) with spontaneous osteonecrosis of the MT were analyzed. The lesion stages assessment showed that 3 (14%) were Stage II, 10 (45%) were Stage III, 7 (32%) were Stage IV, and 2 (9%) were Stage V. In the sagittal plane, 7 (32%) were in the anterior region (MTa) and 15 (68%) were central (MTc). The lesion volume averaged 2.24 ± 0.79 cm3 (range: 1.57–3.08 cm3). Seventeen patients (77%) had Level III posterior medial meniscus root tears (MMRTs). All the patients underwent UKA. Average follow-up was 30.0 ± 6.4 months with a range of 23.0–38.0 months. The visual analog scale score was 7.78 ± 0.67 before surgery while decreased to 2.22 ± 1.09 at the final follow-up (P < 0.001). The Hospital for Special Surgery scores of pre-/post-surgery were 65.67 ± 5.45 and 84.10 ± 4.20, respectively (P < 0.001). Conclusions: SONK often occurs in the anterior and central tibial plateau due to abnormal stresses. Most of the patients had Level III posterior medial meniscus root tears. MRI is recommended for suspected cases to identify SONK at an early stage. The use of the Oxford Medial UKA for SONK of the MT is reliable both immediately and at follow-up.

 

 Abstract in Chinese

膝关节胫骨平台自发性骨坏死的临床特征及治疗方法探讨

摘要

背景:膝关节自发性骨坏死常常无法早期诊断出来。膝关节自发性骨坏死晚期,常需要行关节置换术。在一小部分病例中,膝关节自发性骨坏死涉及胫骨内侧平台。本文在回顾性病例研究的基础上,介绍了发生于胫骨内侧平台的自发性骨坏死的临床特点,及利用单髁置换术进行治疗该疾病的临床疗效。

方法:从2015年3月至2016年6月,在广东省中医医院就诊,利用磁共振成像检查证实,诊断为胫骨内侧平台的自发性骨坏死患者被纳入研究,并进行回顾性分析。所有患者都接受牛津内侧单髁置换术。该部分病人的病变特点、治疗方法及随访结果均被记录和评估。利用Ficat and Arlet分期对坏死部分的分期和评分。

结果:本研究共纳入了22例诊断为胫骨内侧平台自发性骨坏死的患者,其中男性5例,女性17例,平均年龄64.1岁。坏死分级:II级3例(13.64%),Ⅲ级10例(45.45%), IV级7例(31.82%), V级2例(9.09%)。所有坏死灶均位于胫骨内侧平台。在矢状位上,坏死灶位于胫骨平台前1/3者7例(31.82%),坏死灶位于胫骨平台中1/3者15例(68.18%)。坏死灶平均体积2.24 ± 0.79 cm3 (范围:1.57-3.08 cm3)。有17例(77.27%)患者合并了内侧半月板后角Ⅲ度损伤,没有1例患者合并了外侧半月板后角Ⅲ度损伤。所有患者均行内侧单髁置换术,没有感染、松动等并发症发生,平均随访时间30.0 ± 6.4月(23-38月)。所有患者对手术的疗效评价满意。VAS评分从术前7.78 ± 0.67分下降到末次随访时2.22 ± 1.09;HSS评分从术前65.67 ± 5.45分到末次随访时84.1 ± 4.20分;两者前后比较均有统计学意义(P<0.001)。

结论:由于应力异常,发生于胫骨内侧平台的自发性骨坏死,常常在胫骨前部和中部出现;该部分患者常合并内侧半月板后角损伤。对于该病的诊断和鉴别,建议尽早行MRI检查。利用牛津单髁置换术治疗胫骨内侧平台的自发性骨坏死的早中期疗效满意。



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