单髁置换与全膝置换患者膝关节评分的比较:随机对照试验

Knee scores of patients undergoing unicompartmental knee arthroplasty and total knee arthroplasty: a randomized controlled trial

背景:单髁置换治疗骨关节炎被越来越多的学者所接受,但仍有部分学者认为行全膝置换是更好的选择。目的:对比单髁置换与全膝置换患者置换前、后的膝关节评分。方法:纳入2013年3月至2014年11月在新疆医科大学第一附属医院行单髁置换并得到随访的膝骨关节炎患者53例,并选取同期行全膝置换并得到随访的患者53例。记录两组患者置换前与末次随访的膝关节评分,包括KSS评分、WOMAC评分、OKS评分、HSS评分,并于末次随访时记录膝关节最大屈曲角度及患者满意度。结果与结论:排除两组中出现并发症的患者后,两组患者末次随访的膝关节评分均较置换前明显提高(P<0.05),两组末次随访的膝关节评分差异无显著性意义(P>0.05);单髁置换组末次随访的膝关节最大活动度大于全膝置换组(P<0.05);两组患者的满意度相近,且与WOMAC评分及OKS评分关联性较高。说明单髁置换只要把握严格的适应证、标准的置换操作及良好的置换后功能锻炼,可与全膝关节置换一样提高患者的生活质量,但其长期疗效仍需进一步观察。

BACKGROUND：Unicompartmental knee arthroplasty for osteoarthritis can be accepted by more and more scholars, but some scholars believe that total knee arthroplasty is a better choice. OBJECTIVE：To compare knee scores between patients before and after unicompartmental knee arthroplasty and total knee arthroplasty. METHODS：A total of 53 patients with knee osteoarthritis, who underwent unicompartmental knee arthroplasty in the First Affiliated Hospital of Xinjiang Medical University from March 2013 to November 2014 and obtained fol ow-up, were enrol ed in this study. Simultaneously, 53 patients, who received total knee arthroplasty in the same period and obtained fol ow-up, were selected. Knee scores before surgery and in final fol ow-up were recorded in both groups, including KSS score, WOMAC score, OKS score and HSS score. The knee maximum flexion and patient satisfaction were recorded in final fol ow-up. RESULTS AND CONCLUSION：Patents with complications were excluded in both groups. Knee scores were significantly higher in final fol ow-up than in pre-operation （P〈0.05）. No significant difference in knee scores was detected in final fol ow-up between the two groups （P〉0.05）. Maximum range of motion in final fol ow-up was significantly larger in unicompartmental knee arthroplasty group than in total knee arthroplasty group （P〈0.05）. Patient satisfaction was similar between the two groups. Moreover, the association between WOMAC scores and OKS scores was high. These results suggest that unicompartmental knee arthroplasty could improve patient’s quality of life as total knee arthroplasty so long as physicians grasp strict indications;standard replacement operation and good functional exercise after replacement, but its long-term outcomes stil need further investigations.