单髁与全膝置换治疗老年单间室骨关节炎比较

Unicompartmental versus total knee arthroplasty for treatment of isolated compartmental knee osteoarthritis in the elderly

[目的]比较单髁置换(UKA)与全膝置换(TKA)治疗老年膝关节单间室骨关节炎的近期临床疗效。[方法]回顾性分析2008年3月~2010年3月本院收治膝关节单间室骨关节炎患者43例,20例接受UKA治疗,23例接受TKA治疗。对比两组患者术前及末次随访膝关节屈曲活动度(ROM)、膝关节学会评分(KSS)、视觉模拟量表评分(VAS)及术中出血量和术后并发症。[结果]术中平均出血量UKA组(193.00±41.81)ml,TKA组(347.83±93.52)ml(P<0.05),TKA组术后5例患者输血,UKA组术后无患者输血(P<0.05)。UKA组术后屈膝到90°所用时间为(3.15±0.75)d,TKA组为(5.83±0.72)d(P<0.05)。术后早期无感染、深静脉血栓发生。患者均获得2年以上随访(平均26.5个月),UKA组术前与末次随访ROM、KSS评分和VAS评分对比,差异有统计学意义(P<0.001),TKA组差异也有统计学意义(P<0.001)。末次随访时UKA组与TKA组间ROM、KSS评分和VAS评分对比,差异无统计学意义(P>0.05)。患者随访期间无假体松动、关节翻修等严重并发症出现。[结论]对于膝关节单间室骨关节炎患者,在严格掌握手术适应证的前提下,UKA与TKA均能显著改善膝关节功能,近期疗效无显著差异。UKA具有创伤小、出血少、恢复快、术后早期膝关节活动度良好等优点,但是长期效果还有待研究。

[Objective] To compare the clinical outcomes between unicompartmental knee arthroplasty （UKA） and to tal knee arthroplasty （TKA） for isolated compartmental knee osteoarthritis in the elderly. [Methods] A retrospective study was conducted on the clinical data of 43 patients with isolated compartmental knee osteoarthritis who were surgically treated from March 2008 to March 2010. Of them, 20 patients underwent UKA while the remaining 23 patients received TKA. Perioper- ative blood loss and complication, additionally, knee range of motion （ROM）, knee society score （KSS） and visual analogue scale （VAS） were compared between the two groups. [Results] The mean blood loss was recorded as （193.00±41.81） ml in the UKA group, while （347.83±93.52） ml in the TKA group, where was statistically different （P〈0.05） . Correspondingly, no blood transfusion was given in any patient of the UKA group, whereas 5 cases of the TKA group received blood transfusion （P〈0.05） . Additionally, the time elapsed for achieving 90° of knee flexion after operation was statistically different be- tween the two groups [ （3. 15±0.75） days vs （5.83±0.72 days）, P〈0.05] . No infection and deep vein thrombosis occurred in any patient of both groups. All of the patients were followed up for more than 2 years with a mean of 26.5 months.The ROM, KSS and VAS statistically improved in the both groups compared the preoperative data with those at the latest follow up （P 〈 0.001） . No prosthesis loosening or revision occurred in any patient of both groups. [Conclusions] This clinical study reveals whether UKA or TKA lead to a parallel short-term outcome. Although UKA has its own advantages of minimal trauma, less blood loss and quick recovery, its value need to be verified by further long-term follow up.