单髁置换与全膝关节置换治疗单间室膝骨关节炎临床对比研究

Comparison study of unicompartmental and total knee arthroplasties in treatment of unicompartmental osteoarthritis

目的探讨膝关节单髁置换术(UKA)与全膝关节置换术(TKA)治疗单间室膝关节骨关节炎近中期疗效。方法随访2014年3月至2016年3月于南通大学附属医院骨关节科进行治疗的年龄大于60岁可应力下矫正内翻畸形的内侧单间室骨关节炎患者,不包括严重骨质疏松、多间室病变的骨关节炎患者。其中接受膝关节单髁置换术(UKA)23例,全膝关节置换术(TKA)27例。收集两组的美国特种外科医院(HSS)膝关节评分、术中出血、Hb下降、疼痛评分、膝关节屈曲至90°所需天数等计量资料,采用t检验对两组计量资料进行比较。采用重复测量方差分析,对两组患者术前术后的HSS评分、疼痛评分进行分析。进一步采用配对样本t检验对同一组手术前后的HSS评分、疼痛评分比较。P<0.05有统计学意义。结果 UKA组23名患者中22例获得完整随访,平均时间为(17±4)个月。TKA组27例全部获得完整随访,平均时间为(15±5)个月。UKA组和TKA组均取得满意疗效,两组患者均未出现假体松动、翻修等严重并发症。HSS评分UKA组术前(64±3)分,末次随访(85±6)分(t=-20.066,P<0.05),差异有统计学意义;TKA组术前(62±3)分,末次随访(83±5)分(t=-22.376,P<0.05),差异有统计学意义。疼痛视觉模拟评分UKA组术前(6.5±0.4)分,末次随访(1.3±0.6)分(t=41.764,P<0.05),差异有统计学意义;TKA组术前(6.61±0.45)分,末次随访(1.5±0.5)分(t=46.664,P<0.05),差异有统计学意义。UKA组与TKA组比较,术中出血量(t=-21.332,P<0.05)、术后3 d血红蛋白下降水平(t=-15.470,P<0.05)、术后膝关节屈曲达90°需要天数(t=-7.341,P<0.05),差异均有统计学意义。两组比较,末次随访HSS评分(P>0.05)、疼痛视觉模拟评分(P>0.05),无统计学意义。结论在把握好适应证的情况下,单髁置换治疗单间室膝骨关节炎可取得与全膝关节置换相似的近中期疗效,且具有创伤更小,恢复更快等优点。

Objective To investigate the early and mid term results of unicompartmental knee arthroplasty(UKA)versus totle knee arthroplasty(TKA)for the treatment of isolated compartmental osteoarthritis of knee.Methods From March 2014 to March 2016,the patients with medial compartment osteoarthritis treated in Hospital Affiliated to Nantong University were followed up.The inclusion criteria were as follows:age over 60 years old,the varus of knee could be corrected with stress correction;the exclusion criteria were as follows:severe osteoporosis and multiple compartment lesions.There were 23 cases of unicompartmental knee arthroplasty(UKA)and 27 cases of total knee replacement(TKA).The data of two groups were collected,including the hospital for special surgery(HSS)knee score,intraoperative blood loss,hemoglobin reduction,pain score,and the number of days needed for flexion of knee joint to 90°.The HSS scores and pain scores of two groups were analyzed by repeated measurement of variance analysis.The paired sample t test was used to compare the HSS scores and pain scores of the same group before and after the operation.Results The UKA group(22 patients)were followed up for four months to 28 months,(17±4)months on average.All 27 cases in TKA group were followed up completely.The average time was(15±5)months(three to 32 months).UKA group and TKA achieved satisfactory curative effects,two groups did not present prosthesis loosening,renovation or other severe complications.HSS score of UKA group was(64±3)preoperatively,and(85±6)at the last follow-up;the difference was statistically significant(t=-20.066,P<0.05).HSS score of TKA group was(62±3)preoperatively,and(83±5)at the last follow-up;the difference was statistically significant(t=-22.376,P<0.05).Preoperative visual analogue score(VAS)of UKA group was(6.5±0.4),and(1.3±0.6)at the last follow-up;the difference was statistically significant(t=41.764,P<0.05).The preoperatively VAS score of TKA group was(6.6±0.5),and(1.5±0.5)at the last follow-up;the difference was statistically significant(t=46.664,P<0.05).The differences between UKA group and TKA group in the intraoperative blood loss(t=-21.332,P<0.05),the level of hemoglobin decline on day 3 after the surgery(t=-15.470,P<0.05),the postoperative days needed for knee flexion to 90°(t=-7.341,P<0.05),all presented statistically significant.The differences in the last follow-up HSS score and VAS score between the two groups were not statistically significant(all P>0.05).Conclusion UKA for the treatment of isolated compartmental osteoarthritis of knee can obtain similar early and mid term results to TKA,with less trauma,faster recovery advantages.