Evolution and status of unicompartmental knee prostheses

背景:单髁关节置换术近年来发展迅速,全球范围内手术量明显增加.但目前尚无关于单髁假体的系统综述.目的:对单髁假体的演变发展历史和现状进行综述,讨论目前常用单髁假体的分类、特点和临床效果,为临床提供指导.方法:检索PubMed和万方数据库与单髁假体和单髁临床效果相关的文章.共检索到文献177篇,排除重复性研究,纳入35篇,加上四大关节登记中心的年度报告4篇,总计纳入39篇文献进行综述.结果与结论:①单髁假体历经60多年的曲折发展已经逐渐成熟,文献报道的10年假体生存率已经超过90％;②目前主流假体主要是以Oxford 3为代表的活动平台和以ZUK和Link为代表的固定平台.两类假体在长期临床效果上并没有明显差异,但失败方式有所不同;③目前,无菌性松动和对侧间室病变的进展仍是单髁假体失败的主要方式;④采用生物固定和基于CT或MRI等影像资料的个性化假体设计可能是未来单髁假体的发展方向.BACKGROUND:Unicompartmental knee arthroplasty has been prevailed in orthopedics,but there is a lack of overview addressing unicompartmental knee prostheses.OBJECTIVE:To review the evolution and current situation of unicompartmental knee prostheses and to discuss its classifications,characters and clinical outcomes,thereby providing guidance for clinical application.METHODS:PubMed and WanFang databases were retrieved for the articles related to unicompartmental knee prostheses and its clinical outcomes.Totally 177 articles were retrieved,and finally 35 eligible articles plus other 4 reports were included after excluding repetitive studies.RESULTS AND CONCLUSION:(1) It has been more than 60 years since the birth of unicompartmental knee prostheses.Despite the difficult in the past,it comes to mature and the survival rate is more than 90％ at 10 years.(2) At present,the most popular prostheses include mobile-bearing (represented by Oxford 3) and fixed-bearing (represented by ZUK and Link).There is no significant difference in clinical outcomes between two designs.However,their differences have been noted in their modes and timing of failures.(3) Aseptic loosening and lateral osteoarthritis progression remain the most common failure modes in unicompartmental knee prostheses.(4) Cementless prostheses and individual unicompartmental knee prostheses based on CT or MRI scan maybe promote the long-term efficacy of unicompartmental knee prostheses.233753-37592