膝关节单髁置换术与全膝关节置换术治疗膝关节内侧间室骨关节炎初期疗效对比

Comparision of short-term effectiveness of unicompartmental knee arthroplasty and total knee arthroplasty for medial compartmental knee osteoarthritis

背景：膝关节单髁置换术（unicompartmental knee arthroplasty,UKA）是治疗膝关节内侧问室骨关节炎的有效方法，但对于其初期疗效尚存在很大争议。目的：探讨UKA和全膝关节置换术（total knee arthroplasty,TKA）在治疗膝关节内侧间室骨关节炎的初期临床疗效，为临床手术方案选择提供参考依据。方法：回顾性分析2011年1月至2016年1月采用Oxford Ⅲ单髁系统治疗膝关节内侧问室骨关节炎患者45例，男21例，女24例，年龄52～78岁，平均（64．5±7．5）岁。并随机选取同期行TKA并得到随访的膝关节内侧间室骨关节炎患者45例，男18例，女27例；年龄52～75岁，平均（63．2±10．0）岁。记录两组患者的手术时间、术中出血量、输血率、术后引流量、住院时间，以及术前、术后7d、术后6个月、末次随访时的膝关节美国特种外科医院（Hss）评分、疼痛视觉模拟（VAS）评分、膝关节活动度（ROM）。结果：全部获得随访，随访时间为6～50个月，平均（25．5±10．5）个月。均无假体松动下沉、脱位及对侧间室病变。两组患者手术情况及术后恢复功能比较，UKA组在手术时间、术中出血量、输血率、术后引流量、住院时间、术后7d及6个月随访时HSS评分、VAS评分、ROM明显优于TKA组（P〈O．05）；末次随访时，两组患者的HSS评分、VAS评分及ROM比较无统计学差异（P〉0．05）。结论：UKA治疗膝关节内侧间室骨关节炎的初期疗效优于TKA，且具有手术时间短、术中出血量少、术后恢复快等优点。

Background： It is persistent controversy on the short-term effectiveness between unicompartmental knee arthro- plasty（UKA） and total knee arthroplasty（TKA） for medial compartmental knee osteoarthritis. Objective： To evaluate the short-term effectiveness of unicompartmental knee arthroplasty（UKA） and total knee arthroplasty（TKA） for medial compart- mental knee osteoarthritis, and provide clinical evidence in operation scheme selection. Methods： From January 2011 to Jan- uary 2016, 45 patients with medial compartmental knee osteoarthritis were treated by UKA, including 21 males and 24 fe- males with average of 64 years （range 52-78years）; and randomly selected 45 TKA patients, including 18 males and 27 fe- males with average of 63 years （range 52-75years） in the same period in our hospital. Two groups were compared according to the time of operation, amount of bleeds, postoperatve blood loss, average stay. The American Hospital for Special Sur- gery （HSS） score, visual analogue scale（VAS） score, range of motion（ROM） were also compared at 7 days, 6month, and the last follow-up. Results： All patients were well followed up by 6 to 50 months（mean 25.5±10.5months）, no prosthetic loosen- ing, dislocation, lesions of contralateral compartment joint developed. Through statistics analysis, The UKA group had obvi- ous advantage to TKA group in the time of operation, amount of bleeds, the rate of transfusion, postoperatve blood loss, av- erage stay, HSS score, VAS score, ROM at 7 day and 6 months（P〈0.05）. But there were no significant differences in the HSS score, VAS score, ROM according the last follow-up（P〉 0.05）. Conclusions： The UKA has better short-term effective- ness than TKA in the treatment of medial compartmental knee osteoarthritis, UKA had advantages such as short time of op- eration, less bleeds and good function recovery.