单髁置换术对膝关节内侧间室骨性关节炎病变患者预后转归的影响

Effect of unicondylar knee replacement on prognostic outcome of patients with medial compartment osteoarthritis of knee joint

目的研究单髁置换术对膝关节内侧间室骨性关节炎病变患者预后转归的效果。方法选取广州中医药大学顺德医院骨伤三科2019年9月至2021年6月收治的149例膝关节内侧间室骨性关节炎病变患者,按照手术方法分为对照组和观察组,其中对照组65例(采用全膝关节置换术治疗),观察组84例(采用单髁置换术治疗),比较两组手术相关指标、疼痛评分、临床效果、股骨内髁参数、并发症发生情况、心理状态及生活质量。结果①观察组手术后术中出血量、术后5 d血红蛋白(Hb)水平下降量等手术相关指标低于对照组(P<0.05)。②观察组术后1 d、3 d、5 d、7 d视觉模拟评分法(VAS)评分均低于对照组(P<0.05)。③术前,纽约特种外科医院膝关节评分(HSS)评分、膝关节屈曲度比较差异无统计学意义(P>0.05);术后6个月,观察组上述指标高于对照组(P<0.05);观察组术后主动屈曲90°所需时间低于对照组(P<0.05),膝关节功能优良率均高于对照组(P<0.05)。④两组股骨内髁参数在冠状位、横断面水平比较差异无统计学意义(P>0.05),观察组矢状位水平低于对照组(P<0.05)。⑤术后6个月后,观察组并发症发生率低于对照组(P<0.05)。⑥术前,两组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分比较差异无统计学意义(P>0.05);术后,观察组上述评分低于对照组(P<0.05)。⑦术前,生活质量各项评分比较差异无统计学意义(P>0.05);术后6个月,观察组上述评分高于对照组(P<0.05)。结论单髁置换术治疗膝关节内侧间室骨性关节炎病变患者,预后转归效果较好。

Objective To study the effect of unicondylar replacement on the prognostic outcome of patients with osteoarthritis of the medial compartment of the knee.Methods 149 patients with medial compartment osteoarthritis of knee joint treated in the third Department of Orthopaedics and Traumatology,Shunde Hospital,Guangzhou University of Traditional Chinese Medicine from September 2019 to June 2021 were selected and divided into control group and observation group according to the surgical methods,of which 65 cases were in the control group(treated with total knee replacement)and 84 cases were in the observation group(treated with unicondylar knee replacement).The operation related indicators,pain scores,clinical effects,femoral medial condyle parameters,complications,and psychological status and quality of life of the two groups were compared.Results①The intraoperative blood loss and the decrease of hemoglobin(Hb)level 5 days after operation in the observation group were lower than those in the control group(P<0.05).②The visual analogue scale(VAS)score of the observation group was lower than that of the control group on day 1,3,5 and 7 after operation(P<0.05).③There was no difference of statistical significance between HSS score and knee flexion before operation(P>0.05).Six months after operation,the above indexes in the observation group were higher than those in the control group(P<0.05).The time required for postoperative active flexion of 90°in the observation group was shorter than that in the control group(P<0.05),and the rate of excellent and good knee function was higher than that in the control group(P<0.05).④There was no difference of statistical significance in the coronal and cross-sectional parameters of the femoral condyle between the two groups(P>0.05),and the sagittal level of the observation group was lower than that of the control group(P<0.05).⑤Six months after operation,the incidence of complications in the observation group was lower than that in the control group(P<0.05).⑥Before operation,there was no difference of statistical significance in the scores of Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS)between the two groups(P>0.05);After operation,the scores of the observation group were lower than those of the control group(P<0.05).⑦There was no difference of statistical significance in preoperative quality of life scores(P>0.05);Six months after operation,the above scores in the observation group were higher than those in the control group(P<0.05).Conclusion Unicondylar knee replacement for patients with medial compartment osteoarthritis of knee joint has a good prognostic outcome.