3种手术方式治疗膝关节内侧间室骨性关节炎早期临床疗效比较

Comparing the early clinical efficacy of three operation modalities in medial knee osteoarthritis

目的:比较腓骨高位截骨术、胫骨高位截骨术及单髁置换术在膝关节内侧间室骨性关节炎治疗中的早期临床疗效。方法:前瞻性研究2015年1月~2018年1月于我院骨一科因膝关节内侧间室骨性关节炎行手术治疗的90例患者,根据手术方式不同分成3组,即腓骨高位截骨术组(HFO组,30例),胫骨高位截骨术组(HTO组,30例),单髁置换术组(UKA组,30例)。观察3组患者手术时间、总失血量、住院时间、总费用、术后切口愈合情况、HSS评分及WOMAC评分。结果:UKA组和HTO组手术时间、住院时间均长于HFO组(P<0.05),而UKA组和HTO组间手术时间、住院时间差异无统计学意义(P>0.05);UKA组和HTO组总失血量均多于HFO组(P<0.05),HTO组总失血量多于UKA组(P<0.05);UKA组和HTO组总费用均高于HFO组(P<0.05),UKA组总费用高于HTO组(P<0.05)。3组患者HSS评分和WOMAC评分与不同时间点上存在交互作用(P<0.05);HFO组术后1个月至末次随访HSS评分均高于术前(P<0.05),WOMAC评分均低于术前(P<0.05);HFO组术后1个月至末次随访间HSS评分和WOMAC评分差异均无统计学意义(P>0.05);HTO组术后1个月至末次随访HSS评分均高于术前(P<0.05),HTO组术后3个月至末次随访HSS评分均高于术后1个月(P<0.05),HTO组术后末次随访HSS评分均高于术后3个月(P<0.05),而HTO组术后3个月和术后6个月、术后6个月和末次随访间HSS评分差异无统计学意义(P>0.05);UKA组术后1个月至末次随访HSS评分高于术前(P<0.05);UKA组术后3个月至末次随访HSS评分高于术后1个月(P<0.05);UKA组术后3个月至末次随访间HSS评分差异无统计学意义(P>0.05);HTO组和UKA组术后1个月至末次随访WOMAC评分均分别低于术前(P<0.05),HTO组和UKA组术后3个月至末次随访WOMAC评分均分别低于术后1个月(P<0.05),HTO组和UKA组术后3个月至末次随访间WOMAC评分差异均无统计学意义(P>0.05);3组患者间HSS评分和WOMAC评分差异均无统计学意义(P>0.05)。结论:HFO、HTO及UKA均是治疗膝关节内侧间室骨性关节炎的有效方法。与HFO比较,UKA和HTO治疗膝关节内侧间室骨性关节炎的早期疗效更确切,但费用更高、出血更多、住院时间更长。

Objective:To compare the early clinical efficacies of high fibial osteotomy,high tibial osteotomy and unicompartmental knee arthroplasty in treatment of medial knee osteoarthritis. Methods:Prospective surgery was performed in 90 patients with medial knee osteoarthritis admitted to our department between January of 2015 and 2018.The patients were equally allocated to HFO group(treated with high fibial osteotomy),HTO group(managed by high tibial osteotomy) and UKA group(treated with unicompartmental knee arthroplasty) by the surgical modality.The three groups were evaluated concerning the operative time,total blood loss,length of hospital stay,total medical cost,postoperative wound healing and scoring by Hospital for Special Surgery(HSS) and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. Results:Patients in UKA and HTO groups had longer operative time and length of hospital stay than those in the HFO group(P<0.05),yet the difference was insignificant between HTO and UKA group( P> 0.05).Total blood loss was lower in UKA and HTO groups than in HFO group,and higher in HTO group than in UKA group(Both P< 0.05).Total medical cost was higher in UKA and HTO groups than in HFO group,and in UKA group than in HTO group(Both P< 0.05).HSS and WOMAC scores were interacted at different time point for the three groups(P<0.05).The scoring by HSS was higher in HFO group one month after surgery and by the final follow-up,and lower by WOMAC compared to preoperation(Both P< 0.05),yet the scoring as HSS and WOMAC remained insignificant in HFO group one month following surgery and by final follow-up( P> 0.05).Increased scoring as HSS was seen in HTO group one month and three months after surgery and by last follow-up(P<0.05),and HSS scoring in HTO group was higher in the final follow-up than in three months after surgery (P<0.05),the difference was insignificant three and six months after surgery( P> 0.05).Patients in UKA group had higher scores by HSS observed in one month and three months after surgery as well as final follow-up(Both P< 0.05),yet there was no difference by the 3rd month and last follow-up( P> 0.05).Lower scoring by WOMAC was seen in HTO and UKA groups one month and three months following surgery and by final follow-up compared to preoperation and one month before surgery,respectively(all P< 0.05),and the difference was insignificant three months after surgery and last follow-up( P> 0.05).There was no difference by HSS and WOMAC scoring among the three groups( P> 0.05). Conclusion:High fibial osteotomy,high tibial osteotomy and unicompartmental knee arthroplasty are well-established treatments for medial knee osteoarthritis.UKA and HTO can be better early clinical outcomes than HFO,yet are associated with higher medical cost,higher total blood loss and prolonged hospital stay.