单髁关节置换术与全膝关节置换术对内侧单间室膝骨关节炎患者围术期指标和膝关节功能和术后并发症的影响

Effects of Unicompartmental Knee Arthroplasty and Total Knee Arthroplasty onPerioperative Indexes, Knee Function and Postoperative Complications inPatients with Medial Unicompartmental Knee Osteoarthritis

目的:探讨单髁关节置换术(Unicompartmental knee arthroplasty,UKA)与全膝关节置换术(Total knee arthroplasty,TKA)对内侧单间室膝骨关节炎患者围术期指标和膝关节功能和术后并发症的影响。方法:回顾性分析2020年3月至2021年6月我院收治的内侧单间室膝骨关节炎患者104例的临床资料,根据手术方式分组,有51例患者行单髁置换术归为UKA组,53例行全膝关节置换术为TKA组,比较两组患者围手术期相关指标,评估并比较两组术前、术后6、12个月的膝关节活动度(Range of motion,ROM),美国特种外科医院膝关节(hospital for special surgery knee score,HSS)评分,比较两种手术方法治疗前后下肢力线矫正情况、术后出现并发症的情况。结果:与TKA组相比,UKA组手术时间、自主屈膝90度所用时间更短,术中出血量更少,术后3d血红蛋白下降量较少,两组差异明显(P<0.01);手术前两组患者ROM、HSS评分没有明显差异(P>0.05),术后6、12个月ROM、HSS评分较术前明显增加(P<0.01),且UKA组术后6、12个月的ROM明显高于TKA组(P<0.01),术后6个月UKA组的HSS评分明显高于TKA组(P<0.05);术后两组患者的髋膝踝角较术前增大(P<0.01),胫股角较术前减小(P<0.01),下肢力线得到矫正,两组间髋膝踝角和胫股角差异不明显(P>0.05);UKA组、TKA组术后并发症的发生率分别为3.92%、18.87%,UKA组并发症发生情况明显低于TKA组(P<0.05)。结论:针对内侧单间室膝骨关节炎患者行单髁关节置换术,相比于全膝关节置换术,手术所需时间、自主屈膝90度所用时间更短,术中出血量更少,术后膝关节活动度、关节功能恢复情况更好,术后并发症较少,因此单髁关节置换术值得临床推广使用。

Objective:To explore the perioperative indexes,knee function,and postoperative complications of patients with medial unicompartmental knee osteoarthritis treated by unicompartmental knee arthroplasty(UKA)and total knee arthroplasty(TKA).Methods:The clinical data of 104 patients with medial unicompartmental knee osteoarthritis who were treated in the hospital from March 2020 to June 2021 were retrospectively analyzed.According to the surgical methods,51 patients underwent unicompartmental knee arthroplasty and were made the UKA group,and the other 53 patients received total knee arthroplasty and were made the TKA group.The perioperative-related indexes of the two groups were compared,and the range of motion(ROM)of the knee joint and hospital for special surgery knee score(HSS)were evaluated and compared between the two groups before surgery and at 6 and 12 months after surgery.The lower limb alignment correction and postoperative complications were compared before and after treatment with the two surgical methods.Results:Compared with the TKA group,the surgical time and 90°voluntary knee flexion time in the UKA group were shorter,the intraoperative blood loss was less and the decrease of hemoglobin was less at 3 days after surgery(P<0.01).There were no significant differences in the ROM and HSS scores between the two groups before surgery(P>0.05),and the ROM and HSS scores at 6 and 12 months after surgery were significantly higher than those before surgery(P<0.01).The ROM of the UKA group at 6 and 12 months after surgery was significantly higher than that of the TKA group(P<0.01),and the HSS score at 6 months after surgery was significantly higher than that of the TKA group(P<0.05).After surgery,the hip-knee-ankle angle of the two groups was enlarged(P<0.01)while the tibiofemoral angle was reduced(P<0.01),and the lower limb alignment was corrected,but the differences in hip-knee-ankle angle and tibiofemoral angle were not significant between the two groups(P>0.05).The incidence rate of postoperative complications at 3.92%in the UKA group was significantly lower than the TKA group at 18.87%(P<0.05).Conclusion:Compared with total knee arthroplasty,unicompartmental knee arthroplasty for patients with medial unicompartmental knee osteoarthritis has a shorter time required for surgery and 90°voluntary knee flexion time,less intraoperative blood loss,better postoperative knee range of motion and joint function recovery and fewer postoperative complications,so unicompartmental knee arthroplasty is worthy of clinical promotion and application.