双膝骨关节炎患者行小切口单髁置换术与全膝关节置换术临床疗效对比分析

The clinical comparison of double knee osteoarthritis patients undergoing unicompartmental knee arthroplasty and total knee arthroplasty

【目的】研究双膝骨关节炎患者分别行小切口单髁置换术（UKA）和全膝关节置换术（TKA）的临床疗效差异。【方法】选择2009年5月至2011年5月患有双侧膝关节单间室骨关节炎的患者30例（60膝）作为研究对象，患者一侧膝关节行UKA，另一侧择期行TKA。男性9例，女性21例，年龄60～79岁，平均69岁。收集两次手术前后患者膝关节美国特种外科医院（HSS）功能评分、术中出血量、术后48 h血红蛋白下降量、术后膝关节完全伸直及屈曲到90°所用的时间，术后患者双侧自我感觉优劣的情况。双侧数据进行t检验。【结果】患者均获得随访，随访时间13～35个月，平均20.5个月。患者均无感染、假体松动、关节翻修等严重并发症。UKA侧膝关节HSS评分由术前的（61±3）分提高至末次随访的（87±3）分（t=11.21，P〈0.001）；TKA侧膝关节由术前的（59±5）分提高至末次随访的（86±3）分（t=17.64，P〈0.001）。UKA术中出血及术后48 h血红蛋白下降均较TKA少（t=11.56和12.38,P〈0.001）。术后膝关节完全伸直及屈曲到90°的时间UKA侧短于TKA侧（t=4.03，P〈0.05）。患者中认为UKA侧术后效果优于TAK侧的患者为21例（70%），认为TAK侧优于UKA侧的5例（16.7%），认为双侧效果无明显差别的4例（13.3%）。【结论】UKA治疗膝关节单侧间隙骨关节炎疗效可与TKA相媲美，且具有创伤小、出血少、术后恢复快等优点。

Objective To study the differences in clinical outcome of double knee osteoarthritis patients undergoing unieompartm ental knee arthrnplasty （UKA） and total knee arthroplasty （TKA）. Methods From May 2009 to May 2012, 30 patients （60 knees） with isolated compartmental osteoarthritis of knees were enrolled. Each patient accepted UKA on one knee, TKA on the other. There were 9 male and 21 female patients, aged from 60 to 79 years, average 69 years. Patients evaluation focused on the hospital for special surgery （HSS） knee score, blood loss, hemoglobin 48 h after the operation, the time of knee being able to flex to 90~ and patients＇ sensation after operation. Collection the UKA side and TKA side data and compare two groups of data. Results All patients were followed up for 13 to 35 months, average 20. 5 months. There were no component loosening and revision. HSS knee score improved significantly in both two groups： UKA group was promoted from 61 ±3 to 87 ±3 （ t = 11.21, P 〈0. 001 ） and TKA group from 59 ＋5 to 86 ± 3 （ t = 17. 64, P 〈 0. 001 ）. Compared with the TKA group, the UKA group had less blood loss （t = 11. 56,P 〈0. 001 ）, and a decrease of hemoglobin 48 h after the operation（t = 12. 38, P 〈 O. 001 ）. The dates of knees being able to flex ≥ 90° after operation were less （ t = 4. 03, P 〈 O. 05 ） in the UKA group. As to therapeutic effects, 70% patients found that UKA was better than TKA; 16. 7% patients had opposite opinion; and 13.3% patients found no differences between their two knees. Conclusions UKA for the treatment of isolated compartmental osteoarthritis of knee shows as well as TKA, and it has less trauma, less blood loss, more rapid postoperative recovery than TKA.