基于倾向性评分匹配的单髁与全膝置换术治疗膝内侧骨关节炎早期效果比较

Comparison of the early efficacy of unicompartmental and total knee arthroplasty in patients with medial compartmental osteoarthritis of the knee:a propensity score matching study

目的探讨单髁置换术(UKA)与全膝置换术(TKA)治疗膝内侧间室骨关节炎患者的早期效果。方法回顾性分析2015年1月至2018年12月北京大学人民医院骨关节科同一组医师诊治的197例膝内侧间室骨关节炎患者的临床资料。男性86例,女性111例,年龄(67.7±10.5)岁(范围:46~92岁)。UKA组101例,TKA组96例。应用倾向性评分匹配法对UKA和TKA患者进行匹配,共41对患者匹配成功。采用t检验、χ^2或Fisher确切概率法比较两组患者围手术期指标和短期随访结果。结果匹配后UKA组与TKA组相比,围手术期指标方面,UKA组术后血红蛋白下降更少[(15.3±6.4)g/L比(20.1±7.5)g/L,t=-3.117,P<0.01],阿片类药物使用剂量更少[(160.5±29.3)mg比(186.1±46.8)mg,t=-2.969,P<0.01],术后住院时间更短[(7.0±2.0)d比(10.0±2.5)d,t=-6.000,P<0.01];关节功能方面,术后1年随访时,UKA组术后关节遗忘感评分更高[(65.1±7.6)分比(58.3±13.9)分,t=2.732,P<0.01],膝前弹响发生更少(P=0.03)。两组患者的术中止血带时间、关节活动度、美国膝关节学会临床评分和术后下肢深静脉血栓发生率的差异均无统计学意义(P值均>0.05)。两组均未发生手术部位感染、假体松动、脱位等并发症。结论UKA治疗膝内侧间室骨关节炎早期效果与TKA相似,且在膝前弹响、关节遗忘感评分、失血量、术后疼痛程度和住院天数等方面优于TKA。

Objective To compare the short-term efficacy of unicompartmental knee arthroplasty(UKA)and total knee arthroplasty(TKA)in the treatment of medial compartmental knee osteoarthritis.Methods A retrospective analysis was performed on 197 patients with medial compartment osteoarthritis of the knee treated by the same group of doctors from January 2015 to December 2018.There were 86 males and 111 females,aged(67.7±10.5)years(range:46 to 92 years),among which 101 cases received UKA and 96 cases received TKA.The UKA and TKA patients were matched by the propensity score matching method,and a total of 41 pairs of patients were successfully matched.The difference of short-term outcomes between the two groups were compared by t test,χ^2 test or Fisher exact probability methods.Results Compared with TKA group,the postoperative reduction of hemogloblin in the UKA group was lower((15.3±6.4)g/L vs.(20.1±7.5)g/L,t=-3.117,P<0.01),opioid dosage was lower((160.5±29.3)mg vs.(186.1±46.8)mg,t=-2.969,P<0.01),and the length of hospital stay was shorter((7.0±2.0)d vs.(10.0±2.5)d,t=-6.000,P<0.01).Forgotten joint score of UKA group was higher((65.1±7.6)vs.(58.3±13.9),t=2.732,P<0.01),the incidence of knee clunk or crepitus was lower(P=0.03).There was no significant difference in the time of surgical tourniquet,range of motion,American knee society clinical score and incidence of deep vein thrombosis in lower extremities between the two groups.No complications such as surgical site infection,prosthesis loosening and dislocation occurred in the two groups.Conclusion The early effect of UKA is similar to that of TKA,and it is better than TKA in the aspects of knee clunk or crepitus,forgotten joint score,blood loss,opioid dosage and postoperative hospital stay.