全膝关节置换术治疗晚期膝关节自发性骨坏死的临床效果分析

Clinical Analysis of Total Knee Replacement for Advanced Spontaneous Osteonecrosis of Knee Joint

目的:分析全膝关节置换术治疗晚期膝关节自发性骨坏死的临床效果。方法:选取2021年1月-2022年1月桂林市人民医院收治的晚期膝关节自发性骨坏死患者60例为观察对象,根据随机数字表法分为对照组和观察组,各30例。对照组给予单髁置换手术治疗,观察组给予全膝关节置换术治疗,比较两组患者近期、远期疗效,手术情况,疼痛评分[疼痛视觉模拟评分法(VAS)]、膝关节功能[膝关节评估系统(HSS)和膝关节功能评分(KSS)]及生活质量[健康调查简表(SF-36)]、并发症发生率、满意度。结果:观察组远期总有效率高于对照组,差异有统计学意义(P<0.05);观察组手术出血量大于对照组,手术时间与住院时间长于对照组,差异有统计学意义(P<0.05);观察组HSS、KSS、SF-36评分高于对照组,差异有统计学意义(P<0.05);观察组治疗满意度高于对照组,差异有统计学意义(P<0.05)。结论:全膝关节置换术治疗晚期膝关节自发性骨坏死的远期疗效和膝关节功能改善更佳,但单髁置换手术的手术情况更优,两种术式的并发症发生率接近。在患者耐受情况下,为提高患者的整体效果,建议首选全膝关节置换术治疗。

Objective:To analyze the clinical effect of total knee replacement in the treatment of advanced spontaneous osteonecrosis of knee joint.Methods:Sixty patients with advanced spontaneous osteonecrosis of knee joint admitted to Guilin People's Hospital from January 2021 to January 2022 were selected as the observation objects,and were divided into control group and observation group according to random number table method,with 30 cases in each group.The control group was treated with unicondylar replacement,and the observation group was treated with total knee replacement.Short-term and long-term outcomes,surgical status,pain score[visual analogue scale of pain(VAS)],knee function[knee Assessment System(HSS)and knee function score(KSS)],quality of life[Health Survey Brief Form(SF-36)],incidence of complications,and satisfaction were compared between the two groups.Results:The long-term total effective rate of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).The operation blood loss in the observation group was greater than that in the control group,and the operation time and hospital stay were longer than that in the control group,the difference was statistically significant(P<0.05).HSS,KSS and SF-36 scores in the observation group were higher than those in the control group,and the difference was statistically significant(P<0.05).Treatment satisfaction in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Total knee replacement had better long-term outcomes and improved knee function in the treatment of advanced spontaneous osteonecrosis of the knee joint,but unicondylar replacement had better outcomes and similar complication rates.In the case of patient tolerance,total knee replacement is recommended as the first choice in order to improve the overall outcome of patients.