单髁置换术与全膝置换术治疗高龄患者膝关节内侧单间室骨关节炎的近期疗效比较

Comparison of short-term effect between unicompartmental knee arthroplasty and total knee arthroplasty in the treatment of single-compartment osteoarthritis of the medial knee in elderly patients

目的比较单髁关节置换术(UKA)与全膝关节置换术(TKA)治疗高龄膝关节内侧单间室骨关节炎患者的近期临床疗效,为手术方案选择提供参考依据。方法回顾性分析赤峰市医院骨关节科2014年12月至2018年12月应用第3代Oxford单髁系统行UKA治疗的高龄膝内侧单间室骨关节炎患者40例(40膝),设为UKA组;并随机选取同期行TKA治疗的高龄膝内侧单间室骨关节炎患者40例(40膝),设为TKA组。UKA组患者行膝关节内侧单间室置换术,术中保留其他间室的软骨、外侧半月板及前、后交叉韧带,安装部分型膝关节假体(第3代Oxford单髁假体)。TKA组行TKA,术中切除内、外侧间室软骨,内、外侧半月板及前、后交叉韧带,安装全膝关节假体(Nexgen假体)。2组患者于术后3、6、12个月行门诊随访,比较术前与末次随访时美国特种外科医院(HSS)评分、视觉模拟评分法(VAS)评分、膝关节活动度、血红蛋白以及术后并发症、输血率及患者住院时间相关指标。数据行t检验、χ^(2)检验。结果2组患者全部获得随访,所有患者均随访至术后12个月,以末次随访结果为准。2组患者术前HSS评分、VAS评分、膝关节活动度、血红蛋白比较,差异均无统计学意义(P>0.05)。2组患者末次随访时HSS评分、VAS评分、膝关节活动度、血红蛋白较术前均有明显改善,差异均有统计学意义(P<0.05)。末次随访时,UKA组患者HSS评分、VAS评分分别为(88.7±4.5)、(1.5±0.3)分,与TKA组[(87.1±5.1)、(1.8±0.4)分]比较,差异均无统计学意义(P>0.05);UKA组患者的膝关节活动度为(121.3±8.4)°,优于TKA组[(110.2±9.6)°],差异有统计学意义(P<0.05),TKA组的血红蛋白为(91.1±16.0)g/L,较UKA组[(106.5±15.8)g/L]下降,差异有统计学意义(P<0.05);UKA组并发症发生率为3例(7.5%),要明显低于TKA组[10例(25.0%)],差异有统计学意义(P<0.05);TKA组输血率为35例(87.5%),要明显高于UKA组[2例(5.0%)],差异有统计学意义(P<0.05);UKA组住院时间为(7.5±1.2)d,与TKA组[(10.3±1.7)d]相比,差异有统计学意义(P<0.05)。结论对于膝关节内侧单间室骨关节炎的高龄患者,采用UKA治疗的近期临床效果较TKA明显,还具有住院时间更短、创伤小、输血率低、术后并发症发生率低、康复快等诸多优点,值得临床推广应用。

Objective To compare the short-term effect between unicompartmental knee arthroplasty(UKA)and total knee arthroplasty(TKA)in the treatment of single-compartment osteoarthritis of the medial knee in elderly patients,and to provide a reference for surgical options.Methods A retrospective analysis was conducted on 40 elderly patients(40 knees)with medial single-compartment osteoarthritis of the knee using the third-generation Oxford unicompartmental system in the Department of Osteoarthritis,Chifeng Municipal Hospital from December 2014 to December 2018,and set them as the UKA group.A total of 40 elderly patients with medial compartment osteoarthritis of the knee(40 knees)who received TKA treatment at the same time were selected as the TKA group.Patients in the UKA group underwent medial unicompartmental knee arthroplasty.During the operation,cartilage in other compartments,lateral meniscus,anterior and posterior cruciate ligaments were preserved,and partial knee prosthesis(the third-generation Oxford single condyle prosthesis)were installed.Patients in the TKA group underwent TKA,in which the cartilage,medial and lateral meniscus and anterior and posterior cruciate ligaments of the medial and lateral compartments were removed,and a total knee prosthesis(Nexgen prosthesis)was installed.The two groups of patients underwent outpatient follow-up at 3,6,and 12 months after surgery.The hospital for special surgery(HSS)score,visual analogue score(VAS),knee joint range of motion,hemoglobin were observed and recorded before and at the last follow-up.The postoperative complications,blood transfusion rate and length of hospital stay were compared between the two groups.Data wasprocessed with t test,chi-square test.Results All patients in the two groups were followed-up,and all patients were followed-up to 12 months after surgery,and the results of the last follow-up were taken as the criterion.There were no statistically significant differences in HSS score,VAS score,knee joint range of motion,and hemoglobin between the two groups of patients before operation(P>0.05).The HSS score,VAS score,knee range of motion,and hemoglobin of the two groups at the last follow-up were significantly improved compared with those before the operation,and the differences were statistically significant(P<0.05).At the last follow-up,the HSS score and VAS score in the UKA group were(88.7±4.5),(1.5±0.3)points,respectively,compared with the TKA group[(87.1±5.1),(1.8±0.4)points],the differences were not statistically significant(P>0.05).The knee range of motion of the UKA group was(121.3±8.4)°,which was better than that of the TKA group[(110.2±9.6)°],the difference was statistically significant(P<0.05).The hemoglobin of the TKA group was(91.1±16.0)g/L,compared with the UKA group[(106.5±15.8)g/L],the difference was statistically significant(P<0.05).Complications rate in the UKA group was 3 cases(7.5%),which was significantly lower than that in the TKA group[10 cases(25.0%)],and the difference was statistically significant(P<0.05).The blood transfusion rate in the TKA group was 35 cases(87.5%),which was significantly higher than the UKA group[2 cases(5.0%)],and the difference was statistically significant(P<0.05).The patient hospitalization time in UKA group was(7.5±1.2)d,compared with TKA group[(10.3±1.7)d],the difference was statistically significant(P<0.05).Conclusions For the elderly patients with single-compartment osteoarthritis of the medial knee,the short-term clinical effect of UKA treatment is more obvious than that of TKA.It also has shorter hospital stay,less trauma,lower blood transfusion rate,fewer postoperative complications rates,faster recovery,etc.The advantages are worthy of clinical application.