三种术式治疗膝骨关节炎的凝血与临床比较

Effect of three surgical procedures for knee osteoarthritis on coagulation and clinical outcomes

[目的]比较胫骨高位截骨术(high tibial osteotomy, HTO)、单髁置换术(unicompartmental knee arthroplasty, UKA)及全膝置换术(total knee arthroplasty, TKA)治疗膝骨关节炎(knee osteoarthritis, KOA)的凝血和临床效果。[方法]回顾性分析2015年1月-2018年12月本院治疗的99例内侧间室KOA患者的临床资料。依据术前医患沟通结果,34例采用HTO,33例采用UKA,32例采用TKA。比较凝血-纤溶系统检测和临床结果。[结果]与术前相比,术后1d三组和PT、APTT、FDP、D-D均显著升高(P<0.05);术后7 d又下降至术前水平(P>0.05)。术后1 d,PT、APTT、FDP和D-D由低至高均依次为:UKA组<HTO组<TKA组,差异均有统计学意义(P<0.05)。三组均顺利完成手术,切口长度、术中失血量由低至高依次为:UKA组<HTO组<TKA组,差异均有统计学意义(P<0.05)。患者均获随访,平均(27.8±2.6)个月,随时间推移,三组VAS评分显著减少(P<0.05),HSS评分及ROM均显著增加(P<0.05)。术后半年和术后1年,VAS、HSS评分及ROM由优至劣依次为UKA组、HTO组、TKA组,差异有统计学意义(P<0.05),术后2年三组间上述指标差异均无统计学意义(P>0.05)。[结论]三种术式治疗内侧间室KOA的中远期疗效相当,但UKA近期疗效优于HTO和TKA,且对凝血系统影响小。

[Objective] To compare the effects of high tibial osteotomy(HTO), unicompartmental knee arthroplasty(UKA) and total knee arthroplasty(TKA) on coagulation fibrinolytic system and clinical outcomes for knee osteoarthritis(KOA). [Methods] A retrospective study was conducted on 99 patients who received surgical treatment for medial KOA in our hospital from January 2015 to December 2018.According to preoperative doctor-patient communication, 34 patients received HTO, 33 patients underwent UKA, and 32 patients were treated with TKA. The documents regarding to coagulation-fibrinolytic system and clinical consequences were compared. [Results] Compared with those preoperatively, the PT, APTT, FDP and D-D significantly increased in all the three groups 1 day after operation(P<0.05), and then returned to the preoperative level at 7 days after operation(P>0.05). At 1 day after operation, PT, APTT, FDP and D-D were ranked from low to high in the following order: UKA group < HTO groupHTO group > TKA group, with statistically significant differences(P<0.05), whereas which became not statistically significant among the three groups at 2 years after operation(P>0.05). [Conclusion] The three surgical procedures for treatment of medial compartment KOA is comparable in the middle and long-term outcomes, however, the UKA is better than HTO and TKA in short-term outcomes with little impact on the coagulation system.