胫骨高位截骨与单髁置换手术治疗内侧间室骨关节炎的疗效对比分析

Comparison of the clinical efficacy of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of knee osteoarthritis

目的对比分析胫骨高位截骨术(HTO)及单髁置换术(UKA)治疗内侧间室骨关节炎(OA)的临床疗效。方法回顾性分析2015年1月至2017年6月河北医科大学第一医院骨二科行HTO(20例)及UKA(18例)治疗并获得完整随访的内侧间室骨关节炎患者的临床资料共38例。对比分析两种治疗方式下两组患者的手术时间、术中出血量,经至少2年随访对比不同组疼痛视觉模拟评分(VAS),膝关节学会评分(KSS)、西安大略和麦克马斯特大学关节炎指数(WOMAC)评分等指标。结果两组患者手术时间差异无统计学意义(P=0.616),UKA术中出血量较HTO减少71.7 ml,末次随访结果显示HTO及UKA均可显著提高OA患者膝关节功能。术后HTO组和UKA组患者VAS评分、KSS评分及WOMAC评分分别为(2.6±0.3)、(87.5±4.1)、(11.2±2.7)分及(1.8±0.4)、(95.5±2.2)、(9.3±1.8)分;但3项指标组间对比差异均无统计学意义(均P>0.05)。结论适应证合适的情况下,HTO及UKA均可显著提高关节炎患者膝关节功能,两种术式的选择需综合考虑临床及患者等方面因素。

Objective To compare and analyze the clinical efficacy of high tibial osteotomy(HTO)and unicompartmental knee arthroplasty(UKA)in the treatment of knee osteoarthritis(KOA).Methods From January 2015 to June 2017,38 patients with KOA who underwent HTO(20 cases)and UKA(18 cases)in Second Deparetment of Orthopedic Surgery,First Hospital of Hebei Medical University,were enrolled.Operative duration and intraoperative blood loss were recorded.Visual analogue score(VAS)、Knee Socirty Score(KSS)and Western Ontario and McMaster Universities Arthritis Index(WOMAC)were analyzed after more than two years follow up.Results There was no significant difference in operative time between the two groups(P=0.616).Intraoperative blood loss in UKA was 71.7 ml less than that in HTO.The results of the last follow-up showed that both HTO and UKA could significantly improve the knee function of OA patients.The scores of VAS,KSS and WOMAC in the two groups were(2.6±0.3),(87.5±4.1),(11.2±2.7)and(1.8±0.4),(95.5±2.2),(9.3±1.8),respectively.However,there was no statistically significant difference of the three index between the two groups(all P>0.05).Conclusions HTO and UKA can significantly improve the knee joint function of patients with arthritis if the indications were selected appropriately.The selection of two surgical methods should take clinical and patient factors into consideration.