对膝单髁置换术与全膝置换术治疗老年膝前内侧骨关节炎效果的比较

Comparison of the effects of unicondylar and total knee arthroplasty in elderly patients with anterior medial osteoarthritis of knee

目的 比较膝单髁置换术(UKA)与全膝置换术(TKA)治疗老年膝前内侧骨关节炎(KOA)的临床效果。方法 对2018年1月至2019年6月新疆医科大学附属中医医院骨二科行手术治疗的老年膝内侧单间室KOA患者308例的临床资料进行回顾性分析。依据所采用的术式将患者分为UKA组(181例)和TKA组(127例)。记录全部患者的手术时间、术中出血量、住院时间、手术结束至第一次行走时间以及术后并发症发生率等观察指标;对两组患者术前及术后1个月、3个月、6个月、1年、2年和3年的疼痛视觉模拟评分(VAS)、美国特种外科医院膝关节评分(HSS)、膝关节活动度(ROM)和西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分进行组内与组间比较。结果 UKA组患者的手术时间、术中出血量、手术结束至第一次行走时间和住院时间均显著低于TKA组(均P<0.05)。两组患者术后VAS,HSS,ROM和WOMAC评分较术前均有显著改善(均P<0.05)。UKA组患者ROM和WOMAC评分优于TKA组。术后UKA组出现伤口愈合延迟1例、皮肤切口感染1例和下肢静脉血栓形成3例,TKA组出现因糖尿病导致伤口愈合延迟2例、深部感染2例和下肢静脉血栓形成4例,两组患者的并发症发生率差异无统计学意义(P>0.05)。结论 UKA和TKA对老年膝前内侧KOA均有较好的疗效;UKA在促进术后膝关节功能的恢复、减少术后并发症方面优于TKA,可取得更满意的临床效果和预后。

Objective To compare the clinical efficacy of unicondylar knen arthroplasty(UKA) and total knee arthroplasty(TKA) in the treatment of elderly medial compartment osteoarthritis of knee.Methods Clinical data of 308 elderly patients with medial compartment osteoarthritis of knee treated in the Second Department of Orthopaedics,Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University from January 2018 to June 2019 were analyzed retrospectively.All patients were divided into UKA group(181 cases) and TKA group(127 cases) according to the operation.The perioperative clinical indicators including operation time,intraoperative blood loss,length of hospital stay,time between the end of procedure and the patient's first walk and postoperative complication rate were recorded and compared between the 2 groups.The visual analogue scale(VAS) score,Hospital for Special Surgery(HSS) knee score,range of motion(ROM) of knee and The Western Ontario and McMaster Universities(WOMAC) score before operation and one month,3 months,6 months,one year,2 years and 3 years after operation were recorded and compared between the 2 groups.Results The perioperative indicators of the UKA group including operation time,intraoperative blood loss,time between the end of procedure and the patient's first walk and length of hospital stay were significantly improved than those of the TKA group(all P<0.05).The postoperative VAS,HSS,ROM and WOMAC scores of each group were significantly better than those before operation(all P<0.05).ROM and WOMAC scores were significantly better in the UKA group than that in the TKA group.Complications included one case of delayed wound healing,one case of skin incision infection and 3 cases of lower extremity venous thrombosis in the UKA group,and 2 cases of delayed wound healing due to diabetes,2 cases of deep infection and 4 cases of lower extremity venous thrombosis in the TKA group.No significant difference was found in complication rate between the 2 groups(P>0.05).Conclusion Both UKA and TKA are effective for elderly patients with medial compartment KOA.UKA is superior to TKA in promoting the recovery of knee function and reducing postoperative complications,and can achieve more satisfactory clinical effect and prognosis.