膝關節(jié)冠狀面對線CPAK分類系統(tǒng)_不是所有的膝關節(jié)、全膝關節(jié)置換都是一樣的（2024）Notallkneesarethesame?MacDessiSJ,vandeGraafVA,WoodJA,Griffiths-JonesW,BellemansJ,ChenDB.Notallkneesarethesame[J].BoneJointJ,2024,106-B(6):525-531.?轉(zhuǎn)載文章的原鏈接1：https://pubmed-ncbi-nlm-nih-gov-443.vpnm.ccmu.edu.cn/38821506/?轉(zhuǎn)載文章的原鏈接2：https://boneandjoint.org.uk/Article/10.1302/0301-620X.106B6.BJJ-2023-1292.R1?AbstractTheaimofmechanicalalignmentintotalkneearthroplastyistoalignallkneesintoafixedneutralposition,eventhoughnotallkneesarethesame.Asaresult,mechanicalalignmentoftenaltersapatient’sconstitutionalalignmentandjointlineobliquity,resultinginsoft-tissueimbalance.ThisannotationprovidesanoverviewofhowtheCoronalPlaneAlignmentoftheKnee(CPAK)classificationcanbeusedtopredictimbalancewithmechanicalalignment,andthenofferspracticalguidanceforbonebalancing,minimizingtheneedforsoft-tissuereleases.全膝關節(jié)置換術中的機械對線的目的是將所有膝關節(jié)對線到一個固定的中立位置，盡管并非所有膝關節(jié)都相同。因此，機械對線通常會改變患者的固有對線和關節(jié)線傾斜度，導致軟組織失衡。本文概述了如何使用“膝關節(jié)冠狀面對線（CPAK）”分類來預測機械對線引起的失衡，并提供了實用的指導，以平衡骨骼，減少對軟組織釋放的需要。?IntroductionIrrespectiveofthealignmentstrategyusedwhenundertakingtotalkneearthroplasty(TKA),surgeonsmustcontendwiththefactthatnotallkneesarethesame.InmechanicallyalignedTKA,balancingisusuallyperformedfollowingcompletionofthebonycutsandassessmentofthelaxityofthesoft-tissues.1Thelong-standingapproachforachievingbalanced“gaps”hasbeenbyreleasingorlengtheningligamentousandcapsularstructures,therebyalteringtheirinherentphysiologicalfunction.1,2Withagreateracceptancethatligamentsdonotcontract,3andthatimbalanceresultsfromsurgicalalterationstothepatient’sconstitutionalalignment,4amorenuancedapproachwith“bonebalancing”hasbeensuggested.5Bonebalancingmodifiesthealignmentbybiasingbonyresectionstowardsamoreconstitutionalorientation,therebymaintainingtheirfunctionandreducingthenecessityforsoft-tissuereleases.BonebalancingusinganinitialmechanicalalignmentplanrepresentsoneendofthespectrumofTKAalignmentstrategies,withunrestrictedkinematicalignmentattheother.6-10Subtlechangesofalignmentupto3°fromaneutralmechanicalaxisareoftenenoughtoimproveimbalance,andstillconsideredsafeforsurgeonswhowanttomaintainalignmentwithinthismoretraditionalwindow.11,12Restoringtheknee’sconstitutionalalignmentismorelikelytoachievesoft-tissuebalancecomparedwithusingmechanicalalignmentforallpatients.13,14TheCoronalPlaneAlignmentoftheKnee(CPAK)classificationisawidelyadoptedandpragmaticsystemthatoffersaframeworktounderstandtherelationshipbetweenthenativelowerlimbalignmentandjointlineobliquity(JLO)tothesoft-tissuebalance.14CPAKdefinesninekneephenotypesbasedonconstitutionalalignmentoftheknee,incorporatingthearithmetichip-knee-ankleangle(aHKA)andthejointlineobliquity.Inthisinstructionalreview,weusetheCPAKclassificationtounderstandwhynotallkneesarethesameintermsofimbalancewhenperformingmechanicallyalignedTKA.EachCPAKtypewillbeintroducedbasedonitsprimaryradiologicalandmorphologicalcharacteristics.AlterationstoconstitutionalalignmentthatresultwhenperformingmechanicallyalignedTKAwillbepresentedforeachCPAKtype,alongwiththeanticipatedchallengeswithbalance.Formostsurgeonswhousemechanicalalignment,andforthosewhohavenowadoptedanindividualizedapproach,understandingtheseconceptsisimportantforappreciatingwhyalignmentmatters.?RadiologicalassessmentPreoperativelonglegimagingthatallowsforassessmentofthemechanicalaxisisobtainedusingplainradiographswithdigitalstitching,biplanarimagingorwhole-legCTimaging.Thelateraldistalfemoralangle(LDFA)ismeasuredasthelateralanglesubtendedbythemechanicalaxisofthefemurandthearticularlinetangentialtothedistalfemoralarticularsurface.Themedialproximaltibialangle(MPTA)ismeasuredasthemedialanglesubtendedbythemechanicalaxisofthetibiaandthearticularlinetangentialtotheproximaltibialarticularsurface(Figure1).Apartfromhighlightinglossofjointspace,shortradiographsofthekneeareofnovalueintheassessmentofconstitutionalalignment,andthereforeoftheindividual’skneephenotype.15,16??Fig.1Longlegstandingradiographsshowingthemechanicalaxesofthefemurandtibia.Therightkneeshowsmeasurementofconstitutionalalignmentinanarthritickneeusingthearithmetichip-knee-ankleangle(aHKA)algorithm.Theleftnormalkneeshowsmeasurementofthethemechanicalhip-knee-ankleangle(mHKA).LDFA,lateraldistalfemoralangle;MA,mechanicalaxis;MPTA,medialproximaltibialangle.??TheconstitutionalcoronalalignmentiscalculatedusingtheequationaHKA=MPTA–LDFA,andtheconstitutionaljointlineobliquity(JLO)usingtheequationJLO=MPTA+LDFA.TheboundariesforconstitutionalalignmentofthelowerlimbusingtheaHKAarevarus<-2°,neutral-2°to+2°inclusive,andvalgus>2°.TheboundariesforconstitutionalJLOareapexdistal<177°,neutral177°to183°,andapexproximal>183°.TheCPAKtypeisthendeterminedbasedontheseboundaries(Figure2).??Fig.2TheCoronalPlaneAlignmentoftheKnee(CPAK)classificationwithboundaries.aHKA,arithmetichip-knee-ankle;JLO,jointlineobliquity.??DatafrompreviousstudiessupportthedescriptionsofeachCPAKtypediscussedhere.Alignmentcharacteristicsarederivedfromasampleof500kneesin250healthyadults,agedbetween20and27years(SupplementaryTablei);13soft-tissuelaxitydataarederivedfromasampleof137kneescomparingbalancebetweendifferentalignmentstrategies(SupplementaryTableii);17andloadsensordataarederivedfromasampleof138kneescomparingcompartmentalloadsbetweenalignmentstrategies(SupplementaryTableiii).4Inthisannotation,onlyCPAKTypesItoVIarediscussed,asmanyauthorshaveshownthatTypesVIItoIXarerareinthegeneralpopulation.14,18-23FortheLDFAandMPTA,wecharacterizeorientationas“neutral”if≤1°from90°;“mild”if>1°and≤2°from90°;“moderate”if>2°and≤4°from90°;and“significant”if>4°from90°.DescriptiveradiologicalmeasurementsandschematicphenotypictraitsarepresentedforeachCPAKtypeandforchangestoJLO.Alterationsinconstitutionalalignment,nativefemoraljointlineanatomy,lateralfemoralcolumnlength,andtheirsequelaearesummarizedinTableI.??TableI.TheimplicationsofmechanicalalignmentbasedonCoronalPlaneAlignmentoftheKneetype.CPAK,CoronalPlaneAlignmentoftheKnee;MA,mechanicalalignment;N/A,notapplicable.??CPAKTypeIThekneesin133ofthesampleofhealthyindividuals(26.6%)wereCPAKTypeI.ThisisthemostprevalentphenotypeinAsianandIndianpatientsundergoingTKA,andisthemostcommonvarusphenotypeglobally.18,19,23Thistypeischaracterizedbysignificantproximaltibialvarusandmilddistalfemoralvalgus,resultinginavarusaHKAandanapexdistalJLO.TheimplicationsformechanicalalignmentareshowninFigure3a.MehanicalalignmentwithCPAKTypeIkneesresultsinconsiderabletightnessoftheMCLduetotheshiftinaHKAfromvarustoneutral.Asthemagnitudeofchangeincreases,sodoesthelikelihoodoflateralcondylarlift-off,asignalofmajorimbalance.TheMCListightinbothextensionandflexion.Commonly,surgeonspartiallyorcompletelyreleasetheMCLinanattempttoachievebalance,butsecondaryincompetenceoftheMCLmayresultfromreleasingthiscriticalstructure.Alterationofconstitutionalvarustoneutralwillincreasethelengthoftheleg,andincreasetheneedforathickerpolyethyleneinserttocompensatefortheartificialincreaseinmedialgapheight.24AstheprimarycharacteristicofTypeIistibialvarus,avarustibialrecutwithmechanicalalignmentmayberequiredtoachievebalanceinbothextensionandflexion.??Fig.3Illustrationofsoft-tissueimbalanceinCoronalPlaneAlignmentoftheKnee(CPAK)TypesItoVI,showinghowmechanicalalignment(MA)altersconstitutionalalignmentandjointlineobliquity.a)MAwithCPAKTypeI.Theredwedgehighlightssignificanttibialvarus,andtheredarrowindicateselevationofthemedialjointline.b)MAwithCPAKTypeII.Thegreenwedgeshighlightmoderatefemoralvalgusandmoderatetibialvarus.Theredarrowindicateselevationofthemedialjointline,andtheorangearrowindicatesdistalizationofthelateralfemoralcolumn.c)MAwithCPAKTypeIII.Theredwedgeshighlightssignificantfemoralvalgus,andtheorangearrowindicatesdistalizationofthelateralfemoralcolumn.d)MAwithCPAKTypeIV.Thegreenwedgeindicatesmoderatetibialvarus.Theredarrowhighlightselevationofthemedialjointline.e)MAwithCPAKTypeV.f)MAwithCPAKTypeVI.Thegreenwedgehighlightsmoderatefemoralvalgusandtheorangearrowindicatesdistalizationofthelateralfemoralcolumn.aHKA,arithmetichip-knee-ankleangle;JLO,jointlineobliquity.??CPAKTypeIIThekneesof205ofthehealthyindividuals(41.0%)wereCPAKTypeII.Thisisthemostcommonkneephenotypeglobally.14,22Thistypeischaracterizedbymoderateproximaltibialvarusandmoderatedistalfemoralvalgus,resultinginaneutralaHKAandanapexdistalJLO.TheimplicationsformechanicalalignmentareshowninFigure3b.MechanicallyalignedTKAspecificallyaddressesCPAKTypeIIphenotypiccharacteristics.Asneutralconstitutionalalignmentismaintained,soft-tissuebalanceinextensionisusuallynotaltered.Furthermore,byapplyingexternalrotationtothefemoralcomponent,imbalanceinflexionisunlikely.The“anatomicalalignment”methodattemptedtoreplicateTypeIIbyrecreatinganapexdistalJLO,25butimprecisecuttingguidesresultedinthistechniquebeingabandoned.ThefollowingkinematicalterationsrequireconsiderationinCPAKTypeII.Thenativefemoraljointlineisraisedmediallythroughoutthearcofmotion,apotentialcauseofmid-flexioninstability.26Thelateralfemoralcolumnislengthened(distalized)inextensionandflexion.Ithasbeensuggestedthatthismayleadtoincreasedpatellofemoralretinaculartightnessinflexionbylateraldistalfemoralprostheticoverstuffing,27particularlyinkneeswithveryobliquejointlinessuchasthoseof≤170°.Theneedforsoft-tissuebalancingwithCPAKTypeIIisminimal.?CPAKTypeIIIThekneesof47ofthehealthyindividuals(9.4%)wereCPAKTypeIII.Thistypeisthemostcommonvalgusphenotypeandischaracterizedbyconsiderabledistalfemoralvalgusandmildproximaltibialvarus,resultinginavalgusaHKAandapexdistalJLO.TheimplicationsformechanicalalignmentareshowninFigure3c.Imbalancewithmechanicalalignmentoccursinextensionandtoalesserextentinflexion,astheaHKAisshiftedfromvalgustoneutral.Thedegreeoflateraltightnessisdependentontwovariables:themagnitudeofaHKArelativetothechangeprescribedbymechanicalalignment;andthevariabilityinconstitutionallaxityofthelateralsiderelativetomediallaxity.Inmanyknees,increasedconstitutionallaterallaxity,whichisfurtherincreasedafterresectionofthecruciateligaments,28–30cancompensateforthisshiftinaHKAandreducetheneedforlateralbalancing.However,inourexperience,whenpatientshaveanaHKAof≥5°,soft-tissueimbalanceinevitablyresults.AstheprimarycharacteristicofCPAKTypeIIIissignificantfemoralvalgus,adistalfemoralvalgusrecutmayberequiredtoachievebalanceinextension.?CPAKTypeIVThekneesof21ofthehealthyindividuals(4.2%)wereCPAKTypeIV,whichisararervarusphenotype,characterizedbymoderateproximaltibialvarusandmilddistalfemoralvarus,resultinginavarusaHKAandneutralJLO.TheimplicationsformechanicalalignmentareshowninFigure3d.AswithTypeI,therewillbeMCLtightnessinCPAKTypeIVwithmechanicallyalignedTKA.However,thistightnessismoreprominentinextensionthanflexion.14AsthemajoranatomicalcharacteristicinCPAKTypeIVistibialvarus,avarustibialrecutmayberequiredtorestorebalanceinbothextensionandflexion,althoughanadditionalvarusfemoralrecutcanbeconsidered.?CPAKTypeVThekneesof77ofthehealthyindividuals(15.4%)wereCPAKTypeV,whichisthetargetinmechanicallyalignedTKA.Thistypeischaracterizedbyneutraldistalfemoralandneutralproximaltibialanatomy,resultinginaneutralaHKAandneutralJLO.TheimplicationsformechanicalalignmentareshowninFigure3e.NobalancinginterventionsareusuallynecessaryforCPAKTypeVwithmechanicalalignment.However,unlikeCPAKTypeIIknees,thetibialjointlineisnotchanged,andsurgeonsshouldevaluatewhethertheroutine3°externalrotationofthefemoralcomponentisneeded.?CPAKTypeVIThekneesof16ofthehealthyindividuals(3.2%)wereCPAKTypeVI.Thistypemakesupapproximatelyone-quarterofallvalgusknees,andischaracterizedbymoderatedistalfemoralvalgusandmildproximaltibialvalgus,resultinginavalgusaHKAandneutralJLO.TheimplicationsformechanicalalignmentareshowninFigure3f.ComparedwithCPAKTypeIII,constitutionalvalgusiscontributedtobyfemoralvalgusand,toalesserextent,tibialvalgus.Thisresultsinaneutraljointlineobliquity.Soft-tissueimbalanceismostpronouncedinextension.14AsthemaincharacteristicofTypeVIisfemoralvalgus,avalgusfemoralrecutmayberequiredifthereismarkedlateraltightnessinextension.Ifthereremainssomeimbalance,orwhenfemoralrecutsarepreferablyavoided,areleaseoftheposterolateralcapsular(arcuate)complex,withorwithouttheposteriorbandoftheiliotibialband,maybeconsidered.31?DiscussionThisinstructionalannotationpresentsamethod,basedonconstitutionalalignment,forunderstandingandpredictingthesoft-tissueimbalancethatoftenresultswhenundertakingmechanicallyalignedTKA.Itprovidesclear,alignment-drivenreasoningbasedondeviationstocommonCPAKphenotypes.Imbalancesaremostprofoundinconstitutionalvarusknees,TypesIandIV.However,constitutionalvalgusknees,TypesIIIandVI,alsopresentintraoperativechallenges.Theabilitytounderstandthelikelihoodofencounteringimbalancepriorto,andduring,surgeryisempowering.Theconceptscanalsobeusedbythosewhouseagap-balancingapproachwithconventionalcuttingguides,astheystreamlinetheworkflowofbothtibial-andfemoral-basedtechniques.Mostimportantly,notallkneesarethesame,andtherewillbemuchvariationbetweenindividuals,evenwithineachCPAKtype.Thus,onepatientwithaTypeIIkneemayhaveaLDFAof88°andMPTAof88°,anothermayhaveaLDFAof84°andMPTAof83°.Treatingbothkneeswiththesamemechanicallyalignedresectionsislikelytobringaboutdifferentkinematicresults.Or,whenapatientwithaTypeIkneewithanaHKAof-3°mayonlyrequirea2°varusrecutinordertoobtainabalancedknee,another,alsowithaTypeIknee,butanaHKAof-7°,isunlikelytobebalancedwithasmallvaruscorrectionfrommechanicalalignment.Furthermore,CPAKisaclassificationsystemtodescribephenotypesandisnotgranularenoughtoprovideacomprehensivebreakdownofhowbalancingshouldbeexecutedwhenperformingmechanicallyalignedTKA.Furthermore,itisnotonlytheconstitutionalalignmentbutalsotheconstitutionallaxitythatdeterminesthebalanceofaTKA.Nativelaxitiesarehighlyvariableinboththecoronal(extensionandflexion)andsagittalplanes.32-35Thus,akneecanhaveitsconstitutionalalignmentperfectlyrestored,asinunrestrictedkinematicalignment,butstillhaveunbalancedgaps.17,36TargetingbalancedcoronalandsagittalgapsremainsamajorgoalinTKAandisthecornerstoneofthefunctionalalignmenttechnique.17,36,37However,theoptimalbalance,includingwhetherrectangularortrapezoidalconstitutionalgapsshouldbethenewtarget,remainspoorlydefined.Surgeonsmustcontinuetousetheirclinicalacumentoassesseachkneeonitsmerits,applyingtheknowledgeofoutcomesdeterminedbyphenotype,tooptimizealignmentandbalance.Conventionalcuttingguideswithmechanicalalignmenthavealsobeenreportedtohaveprecisionerrorsof>3°in30%ofcases,38withhalfofthosecasespotentiallydeviatingintomorethan3°varus(15%)andhalfintomorethan3°valgus(another15%).Forexample,ifasurgeonaimingformechanicalalignmentusingconventionalinstrumentsunintentionallyalterstheHKAofakneethathas5°ofconstitutionalvarusto≥4°ofmechanicalvalgus,thiscouldresultinaprofoundchangeinalignmentof9°,thetypeofsituationthatcouldoccurin1in6(15%)ofmechanicallyalignedTKAsundertakenusingconventionalcuttingguides.SeveretightnessoftheMCLwillresultinlateralcondylarlift-off.TheonlywaytocorrectthisimbalanceistoreleasetheMCLfromitstibialinsertion.Thiswillresultinanincreaseinbothmedialflexionandextensiongaps,thesubsequentneedforathickerpolyethyleneinsert,andaneteffectoflengtheningthelimb.24CorrectiontowardsamorevarusphenotypeispreferredtoacompletereleaseoftheMCL.Theinherentlimitationsofconventionalcuttingguidesarethattheydonotallowquantificationorvalidationoftheanglesofresectionorthefinalalignmentofthelimb.Aswegraduallyshifttowardsmorepersonalizedoperationsforourpatients,itishopedthatthisannotationwillencouragesurgeonstoconsidereachpatient’suniqueCPAKtype.This,inpart,maymaketheoutcomesofTKAmorepredictable,reducingtheneedforsoft-tissuereleaseswhileusingadjustmentsinalignmenttorestorethenativebalanceoftheknee.?Takehomemessage-Inthisreview,theCoronalPlaneAlignmentoftheKnee(CPAK)classificationisusedtoenhanceourunderstandingofwhynotallkneesarethesamewhenconsideringsoft-tissueimbalanceinmechanicallyalignedtotalkneearthroplasty.-Bonebalancinginterventionsbasedonanunderstandingofeachpatient’suniqueCPAKtypecanbeusedtoavoidunnecessarysoft-tissuereleases.-Theseconceptsmaybeconsideredbysurgeonsinterestedinamoreindividualizedalignmentstrategy,insteadofafixedmechanicalalignmenttargetforallpatients.在本綜述中，采用“膝關節(jié)冠狀面排列（CPAK）”分類來增強我們對在機械對線全膝關節(jié)置換術中考慮軟組織失衡時為何并非所有膝關節(jié)都相同的理解?；趯γ课换颊擢毺谻PAK類型的理解，可以實施骨平衡干預措施，以避免不必要的軟組織釋放。這些概念可能對有興趣采用更個性化對齊策略的外科醫(yī)生有所幫助，而不是為所有患者設定固定的機械對線目標。

單髁置換UKA的適應癥從初級階段的UKA到現(xiàn)在，UKA的適應癥一直在擴大，禁忌癥越來越少。以前認為年齡、肥胖、髕股關節(jié)損傷等都屬于UKA的禁忌癥。隨著科學技術的發(fā)展，UKA材料和設計不斷改進，目前公認的UKA最佳適應癥包括：1、前內(nèi)側(cè)骨關節(jié)炎（AMOA），股骨內(nèi)側(cè)髁或脛骨內(nèi)側(cè)平臺骨壞死2、前交叉韌帶ACL完好、內(nèi)側(cè)副韌帶MCL功能完好3、外側(cè)軟骨正?；蜉p微退4、內(nèi)翻畸形<15°，屈膝畸形<15°，膝關節(jié)可主動屈曲≥90°UKA的禁忌癥目前對于UKA的禁忌癥，多數(shù)并沒有科學試驗數(shù)據(jù)的直接依據(jù)，而只是絕大多數(shù)專家學者根據(jù)臨床經(jīng)驗做出的符合一般規(guī)律的推斷。主要包括：1、ACL、MCL缺失或嚴重損傷2、關節(jié)內(nèi)畸形不能被手動矯正3、屈膝畸形>15°，麻醉下膝關節(jié)被動屈曲<100°4、外側(cè)間室軟骨缺損5、炎癥性關節(jié)炎（類風濕性關節(jié)炎、化膿性關節(jié)炎、色絨炎等）

單間室膝關節(jié)置換出現(xiàn)于20世紀50年代，在當時處于初級階段的UKA，因假體材料、設計、技術等客觀原因的制約，UKA適應癥很窄而禁忌癥很廣。目前臨床臨床上應用的UKA假體主要有活動平臺（MB）和固定平臺（FB）兩種。1、MB-UKAMB-UKA?可使膝關節(jié)的運動更接近自然生物力學且磨損率低，但易發(fā)生墊片脫位及假體撞擊等并發(fā)癥。襯墊脫位與內(nèi)側(cè)副韌帶碰撞目前MB-UKA的主要代表是Oxford牛津單髁假體，MB-UKA可以使膝關節(jié)的運動更近似于正常的人體膝關節(jié)，減少脛股關節(jié)面的接觸應力，降低墊片的磨損。實現(xiàn)MB-UKA更佳生物力學表現(xiàn)的前提是假體的精準置入，故對術者的手術技術要求更高，學習曲線更長，且存在一定的墊片脫位發(fā)生率。2、FB-UKAFB-UKA較穩(wěn)定，無脫位風險，并發(fā)癥少但磨損率高。FB-UKA主要有ZUK假體和LinkSled假體，手術技術相對簡單，精準度要求相對低，但由于固定平臺的假體設計限制了負荷分散效能，活動時關節(jié)面的受力不能完全均勻分配，導致假體邊緣負荷過重，可能會增加聚乙烯墊片下表面磨損的發(fā)生，故更適合于一些韌帶松弛及活動量要求低的患肢。目前國內(nèi)外文獻對兩者的孰優(yōu)孰劣尚未形成統(tǒng)一標準。

很多親愛的患者咨詢我，膝關節(jié)退變，藥物治療效果不理想，已經(jīng)到了關節(jié)置換的程度，但是不知道做單髁置換術（UKA）還是全膝關節(jié)置換（TKA）。其實，能回答這個問題的專業(yè)醫(yī)師都很少，患者來說，不清楚怎么選擇是很正常的。膝關節(jié)外傷、感染、老化等原因?qū)е玛P節(jié)疼痛，正規(guī)的治療需要進行以下幾個階梯，一般不能馬上選擇開刀。以下四個步驟是目前最權威的治療方案：基礎治療，藥物治療，修復性治療，重建治療，分別對應不同病情階段的關節(jié)炎患者。也就是說，癥狀輕中度的，都不需要置換關節(jié)，到了終末期的膝關節(jié)炎，可以選擇關節(jié)鏡或者關節(jié)置換的治療方案。其中關節(jié)置換針對的是所有其他方法都不奏效的患者。那么，什么是單髁置換術呢。單髁是對應全膝置換而言的“相對微創(chuàng)”的手術，對于膝關節(jié)單側(cè)癥狀的，且符合適應證的患者，推薦選擇單髁置換術（具體適應癥比較專業(yè)，患者有興趣的可以咨詢您的醫(yī)生，不再贅述）。單髁置換術相對來說，可以保留更多的骨量（手術截取的骨頭少），所以，中年左右的、活動量大的患者可以考慮單髁置換術。單髁置換術涉及的專業(yè)知識較多，選擇合適的假體、選擇固定平臺還是活動平臺，都是需要仔細考慮的問題。作為一種保膝的手段，單髁置換術的并發(fā)癥發(fā)生率和病死率相對全膝置換低。但是需要注意的是，單髁置換術不宜擴大適應癥，否則會帶來災難性的后果，不僅不能緩解患者的疼痛，反而增加了費用和翻修的風險。全膝關節(jié)置換術幾乎是關節(jié)炎的最終治療方法。對其他干預措施都無效的患者，無奈之下只能選擇做全膝關節(jié)置換術。糾結(jié)于選擇單髁還是全膝置換，不能建立在是不是微創(chuàng)的角度上片面解釋，解決問題才是最重要的，各種手術都有自己的優(yōu)點和局限性。絕不能搜點資料就對號入座。術式的選擇，這中間的評估過程比較復雜，建議咨詢關節(jié)外科的專業(yè)醫(yī)師。本人熱忱歡迎廣大患者來咨詢關于關節(jié)置換的選擇問題，希望為您解答疑惑。

女性，68歲，因為關節(jié)磨損變形走路困難就診。給予行膝關節(jié)置換，爭得病人的同意，愿意作為科普給大家做示教。術后8個月走路樣子術后8個月晨練術后八個月晨練。良好的適應癥，熟練的手術技術，樂觀積極的心態(tài)，努力的康復鍛煉，造就良好的手術效果。

單間室膝關節(jié)置換出現(xiàn)于20世紀50年代，在當時處于初級階段的UKA，因假體材料、設計、技術等客觀原因的制約，UKA適應癥很窄而禁忌癥很廣。近年來，隨著微創(chuàng)外科技術的發(fā)展和保膝理念的盛行，單髁置換術（UKA）在國內(nèi)逐漸開始流行。?隨著科學技術的發(fā)展，UKA假體材料及設計得到不斷改進，更多優(yōu)質(zhì)的假體類型不斷涌現(xiàn)。?目前臨床臨床上應用的UKA假體主要有活動平臺（MB）和固定平臺（FB）兩種。1、MB-UKAMB-UKA?可使膝關節(jié)的運動更接近自然生物力學且磨損率低，但易發(fā)生墊片脫位及假體撞擊等并發(fā)癥。目前MB-UKA的主要代表是Oxford牛津單髁假體，MB-UKA可以使膝關節(jié)的運動更近似于正常的人體膝關節(jié)，減少脛股關節(jié)面的接觸應力，降低墊片的磨損。?實現(xiàn)MB-UKA更佳生物力學表現(xiàn)的前提是假體的精準置入，故對術者的手術技術要求更高，學習曲線更長，且存在一定的墊片脫位發(fā)生率。2、FB-UKAFB-UKA較穩(wěn)定，無脫位風險，并發(fā)癥少但磨損率高。FB-UKA主要有ZUK假體和LinkSled假體，手術技術相對簡單，精準度要求相對低，但由于固定平臺的假體設計限制了負荷分散效能，活動時關節(jié)面的受力不能完全均勻分配，導致假體邊緣負荷過重，可能會增加聚乙烯墊片下表面磨損的發(fā)生，故更適合于一些韌帶松弛及活動量要求低的患肢。目前國內(nèi)外文獻對兩者的孰優(yōu)孰劣尚未形成統(tǒng)一標準。UKA的適應癥從初級階段的UKA到現(xiàn)在，UKA的適應癥一直在擴大，禁忌癥越來越少。以前認為年齡、肥胖、髕股關節(jié)損傷等都屬于UKA的禁忌癥。隨著科學技術的發(fā)展，UKA材料和設計不斷改進，UKA經(jīng)歷了從實踐到認識、認識又反作用于實踐的前進的、上升的發(fā)展后，社會存在決定社會意識，目前公認的UKA最佳適應癥包括：1、前內(nèi)側(cè)骨關節(jié)炎（AMOA），股骨內(nèi)側(cè)髁或脛骨內(nèi)側(cè)平臺骨壞死2、ACL?完好、MCL功能完好3、外側(cè)軟骨正常或輕微退變4、內(nèi)翻畸形<15°，屈膝畸形<15°，膝關節(jié)可主動屈曲≥90°UKA的禁忌癥?目前對于UKA的禁忌癥，多數(shù)并沒有科學試驗數(shù)據(jù)的直接依據(jù)，而只是絕大多數(shù)專家學者根據(jù)臨床經(jīng)驗做出的符合一般規(guī)律的推斷。主要包括：1、ACL、MCL?缺失或嚴重損傷2、關節(jié)內(nèi)畸形不能被手動矯正3、屈膝畸形>15°，麻醉下膝關節(jié)被動屈曲<100°4、外側(cè)間室軟骨缺損5、炎癥性關節(jié)炎（類風濕性關節(jié)炎、化膿性關節(jié)炎、色絨炎等）?特殊情況在一些文獻中，還可以看到涉及單髁置換術的聯(lián)合或復雜手術的病例：1、UKA+ACL重建2、UKA+HTO3、髕股關節(jié)和內(nèi)側(cè)單髁置換術4、雙室置換小結(jié)?這些病例提醒著我們，適應癥與禁忌癥在某些條件下可以轉(zhuǎn)變。針對不同病人，具體問題具體分析，為患者提供更具個性化的治療方案。

選擇膝關節(jié)鏡、膝關節(jié)置換手術的患者術前一般都是因為各種疾病造成了在關節(jié)活動時出現(xiàn)嚴重的疼痛。而為了避免疼痛的發(fā)生，只能減少關節(jié)的活動。久而久之，造成膝關節(jié)周圍肌肉組織力量減弱、肌肉萎縮、周圍韌帶組織粘連，整個關節(jié)就像一部銹住的機器，失去了正常運動的能力。為了恢復正常的活動能力，術后正確的康復鍛煉來恢復膝關節(jié)的活動度和力量是十分重要的。①股四頭肌+踝泵運動練習-增加您的大腿肌肉力量。盡量伸直您的膝關節(jié)勾住腳踝，每次持續(xù)30到60秒。在30分鐘內(nèi)重復左右腿交叉各15次，這樣的動作，然后休息30分鐘，一直重復練習直到您感覺大腿肌肉很疲憊。建議每天早中晚3組，每組30次。

靠墻靜蹲和金雞獨立：本視頻前半部分為靠墻靜蹲，后半部分為金雞獨立。動作要點見視頻解說?？繅o蹲可以練雙下肢的肌肉力量，我們很多術后患者練靠墻靜蹲后發(fā)現(xiàn)，對側(cè)腿越來越粗而手術那一側(cè)腿越來越細，那是因為靠墻靜蹲的時候主要用力用在對側(cè)腿上了，而如果要練單側(cè)可以用金雞獨立。