微创与传统入路单髁置换术治疗膝关节单间室骨关节炎的疗效比较

Comparison of minimally invasive approach and traditional approach of unicompartmental knee arthroplasty in treatment of medial compartmental knee osteoarthritis

目的:比较微创与传统入路单髁置换术(UKA)治疗膝关节单间室骨关节炎的临床效果。方法:回顾性研究2017年2月至2019年6月行UKA治疗的膝关节单间室骨关节炎患者74例(76膝),根据其手术切口的不同,分为微创入路组40膝与传统入路组36膝。比较两组患者的手术时间、切口长度、手术出血量、疼痛视觉模拟评分(VAS)、美国特种外科医院(HSS)评分、胫股角(FTA)、胫骨后倾角(PSA)、股骨远端外侧角(LDFA)、胫骨近端内侧角(MPTA)及皮肤麻木情况。结果:微创入路组切口长度明显小于传统入路组(P<0.05);传统入路组C-反应蛋白(CRP)值及术后肌酸激酶均高于微创入路组(P<0.05)。微创入路组术后3 d、术后1个月VAS评分均低于传统入路组,差异具有统计学意义(P<0.05)。术后1个月膝关节HSS评分微创入路组高于传统入路组,差异具有统计学意义(P<0.05)。而手术失血量、影像学指标及皮肤麻木情况两组无明显差异。结论:微创入路与传统入路UKA能够取得相似的临床疗效,但微创入路UKA的手术切口小、创伤小、术后疼痛较轻,术后早期膝关节功能优于传统入路UKA。

Objective: To compare the clinical effects of minimally invasive approach and traditional approach for unicompartmental knee arthroplasty(UKA). Methods: Data of 74 patients undergoing unicompartmental knee arthroplasty in our hospital from February2017 to June 2019 were retrospectively analyzed. According to their different surgical incisions, they were divided into minimally invasive approach group(40 knees) and traditional approach group(36 knees). The operation time, incision length, blood loss, visual analogue scale scores(VAS), hospital special scores(HSS), femorotibial angle(FTA), posterior slope angle(PSA), lateral distal femoral angle(LDFA), medial proximal tibial angle(MPTA) and skin numbness were compared between the two groups. Results: The incision length of the minimally invasive approach group was significantly lower than that of the traditional approach group(P<0.05);the C-reactive protein(CRP) value and postoperative creatine kinase in the traditional approach group were higher than those of the minimally invasive approach group(P<0.05). The VAS scores of the minimally invasive approach group were lower than those of the traditional approach group at 3 days and 1 month after surgery(P<0.05). One month after operation, the knee HSS score of the minimally invasive approach group was higher than that of the traditional approach group(P<0.05). There was no significant difference between the two groups in terms of blood loss, imaging indicators and skin numbness. Conclusions: The minimally invasive approach UKA and traditional approach UKA can achieve similar clinical effects,but the minimally invasive approach UKA has advantages of smaller incision, less trauma, less postoperative pain than the traditional approach, and achieves better early postoperative knee joint function.