膝关节单髁置换术的临床应用研究进展

Progress in Clinical Application Research of Unicompartmental Knee Arthroplasty

摘要: 膝骨关节炎(knee osteoarthritis, KOA)是中老年人常见的退行性关节疾病，也是导致慢性疼痛和功能障碍的重要原因。对于终末期单间室KOA患者，单髁置换术(unicompartmental knee arthroplasty, UKA)因保留正常骨量和韧带结构、创伤小、恢复快、功能改善显著等优势，已成为重要的治疗方式。近年来，随着假体设计、材料学及数字化技术的发展，UKA的适应证不断拓展，传统认为属于禁忌证的高体质量指数、前交叉韧带功能不全及年轻患者等，在严格筛选后亦可获得良好疗效。同时，机器人辅助、人工智能导航及个性化假体等新技术进一步提高了假体定位精度和临床效果。但UKA仍存在长期循证证据不足、适应证标准尚未统一、不同假体设计疗效存在争议及机器人辅助成本较高等问题。本文综述近年来UKA在发展历程、适应证、假体设计、临床疗效、并发症及智能化技术等方面的研究进展，以期为临床应用及未来研究提供参考。

Abstract: Knee osteoarthritis (KOA) is one of the most prevalent degenerative joint disorders worldwide and represents a major cause of chronic pain and disability among older adults. For patients with end-stage unicompartmental osteoarthritis, surgical intervention remains the most effective strategy to relieve pain and restore joint function. With continuous advances in minimally invasive surgery, prosthetic design, biomaterials, and digital orthopedic technologies, unicompartmental knee arthroplasty (UKA) has gained increasing popularity because of its advantages, including preservation of bone stock and cruciate ligaments, reduced surgical trauma, rapid postoperative recovery, and superior functional outcomes. Traditional contraindications such as obesity, anterior cruciate ligament deficiency, and younger age have recently been challenged by accumulating evidence, suggesting that patient selection should be individualized rather than based solely on conventional criteria. Furthermore, innovations including cementless fixation, mobile-bearing prostheses, patient-specific implants, robotic-assisted surgery, navigation systems, and artificial intelligence have significantly improved implant positioning accuracy and postoperative functional recovery. Nevertheless, several issues remain unresolved, including limited long-term evidence, controversies regarding patient selection and implant choice, and concerns regarding the cost-effectiveness of emerging technologies. This review summarizes recent advances in UKA with emphasis on indications, prosthetic design, clinical outcomes, complications, robotic-assisted surgery, and future research directions, aiming to provide evidence-based guidance for clinical practice and future investigations.