膝内侧室骨性关节炎全膝与单髁置换早期结果比较

Comparison of short-term outcomes of total knee arthroplasty versus unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee

[目的]比较全膝关节置换术(total knee arthroplasty,TKA)和单髁置换术(unicompartmentalknee arthroplasty,UKA)治疗单纯性膝内侧间室骨性关节炎患者的临床效果。[方法]2017年1月-2020年1月,277例单纯膝内侧间室骨性关节炎纳人本研究。依据术前医患沟通结果,156例采用TKA术,121例采用UKA术。比较两组患者围手术期、随访及影像资料。[结果]UKA组手术时间、切口长度、术中失血量及住院时间均显著优于TKA组(P<0.05)。随访12个月以上,术后随时间推移,两组患者VAS及WOMAC评分均显著减少(P<0.05),而ROM和HSS评分显著增加(P<0.05)。术后3个月,UKA组的HSS、VAS、WOMAC评分及ROM均显著优于TKA组(P<0.05),但末次随访时,两组上述指标的差异均无统计学意义(P>0.05)。影像学方面,与术前相比,末次随访时TKA组的FTA显著减小(P<0.05),而UKA组的FTA无显著变化(P>0.05);两组MPTA均显著增加(P<0.05),而PTS均显著减小(P<0.05)。末次随访时TKA组FTA和PTS显著小于UKA组(P<0.05),而MPTA显著大于UKA组(P<0.05)。[结论]从短期疗效来看,UKA较TKA具有创伤更小、疼痛缓解更明显以及滕关节功能恢复更好等优点。

[Objective]To compare the clinical results of total knee arthroplasty(TKA)versus unicompartmental knee arthroplasty(UKA)for medial compartment osteoarthritis of the knee.[Methods]From January 2017 to January 2020,277 patients with simple medial compartment osteoarthritis of the knee were enrolled in this study.According to the results of preoperative doctor-patient communication,156 patients were treated with TKA,while other 121 patients received UKA.The perioperative,follow-up and imaging data were compared between the two groups.[Results]The UKA group proved significantly superior to the TKA in terms of operative time,incision length,intraoperative blood loss and hospital stay(P<0.05).At the latest follow up lasted more than 12 months,the VAS and WOMAC scores decreased significantly(P<0.05),whereas the ROM and HSS scores significantly increased in both groups compared with those before surgery(P<0.05).The HSS,VAS,WOMAC score and ROM in UKA group were significantly better than those in TKA group at 3 months post-operatively(P<0.05),while which became not statistically significant between the two groups at the latest follow-up(P<0.05).In terms of imaging assessment,the femorotibial angle(FTA)reduced significantly in the TKA group at the last follow-up compared with that before surgery(P<0.05),while which remained unchanged in the UKA group(P<0.05).However,the medial proximal tibial angle(MPTA)increased significantly(P<0.05),whereas the posterior tibial slope(PTS)significantly decreased in both groups at the latest follow up compared with those before operation(P<0.05).At the latest follow up the FTA and PTS in TKA group were significantly less than those in UKA group(P<0.05),while the MPTA in TKA group was significantly greater than that in the UKA group(P<0.05).[Conclusion]In terms of short-term efficacy,UKA has the advantages of less trauma,more obvious pain relief and better recovery of knee function over TKA.