观察同一患者单髁与全膝关节置换治疗单间室膝骨关节炎的对比效果

Observation on comparison of unicompartmental knee arthroplasty and total knee arthroplasty for single compartment knee osteoarthritis in the same patient

目的探讨单髁置换术和全膝置换术在同一患者上治疗膝内侧单间室骨关节炎的短期临床疗效对比。方法回顾性分析2020年1月至2022年9月于中国科学技术大学第一附属医院关节外科接受膝关节牛津单髁置换术和全膝关节置换术两种手术治疗的患者27例。全部病例均由同一主刀医师完成。病例按照患者进行的手术术式先后顺序分为全膝关节置换术(TKA)先行组和单髁置换术(UKA)先行组,手术前后均采用牛津膝关节OKS评分,术后采用患者自评满意度评分(Likert)进行比较。术后随访时间为术后1、3、6个月。采用SPSS 27.0软件对数据进行处理。结果在两组中两种手术术后OKS评分相比术前均有显著下降(P<0.001)。术前OKS评分、术后6个月OKS评分两组间相比差异无统计学意义,而术后1个月和术后3个月UKA患者评分显著优于TKA患者(P_(TKA先行组术后1个月)、P_(UKA先行组术后1个月)<0.001,P_(TKA先行组术后3个月)=0.004、P_(UKA先行组术后3个月)=0.049)。TKA先行组术后1个月和UKA先行组术后3个月术后评分下降程度UKA患者显著高于TKA患者(P_(TKA先行组术后1个月评分下降值)、P_(UKA先行组术后1个月评分下降值)<0.001,P_(UKA先行组术后3个月评分下降值)=0.021),而术后3个月与术后6个月两种手术OKS评分下降程度无显著差异(P_(TKA先行组术后3个月评分下降值)=0.404,P_(TKA先行组术后6个月评分下降值)=0.471,P_(UKA先行组术后6个月评分下降值)=0.640)。TKA先行组患者,对于UKA术式,术后Likert满意率为84.2%,而对于TKA术式满意率为89.5%;对于UKA先行组患者,两种术式患者术后Likert满意率均为87.5%,差异无统计学意义(P>0.05);TKA先行组,患者两种手术的术后恢复良好,满意率均为84.2%,UKA先行时均为87.5%,两组差异均无统计学意义。TKA和UKA先行组所有组内对比趋势基本一致。结论对于膝内侧单间室骨关节炎患者的手术治疗,UKA和TKA在术后早期内都获得了较好的术后功能恢复,而UKA相比TKA术后恢复速度更快。两种术式均获得了较高的患者满意度。

Objective To investigate the difference of short-term clinical efficacy between unicompartmental knee arthroplasty and total knee arthroplasty in the treatment of single compartment osteoarthritis of medial knee in the same patient.Methods A retrospective analysis was performed on 27 patients who underwent Oxford unicompartmental knee arthroplasty and total knee arthroplasty in the Department of Joint Surgery in the First Affiliated Hospital of University of Science and Technology of China from January 2020 to September 2022.Follow-up time was 1 month,3 months and 6 months after surgery.All cases were completed by the same surgeon.The Oxford knee score and Likert were used before and after the surgery.SPSS 27.0 software was used to process the data.Results All cases were divided into TKA-fore and UKA-fore groups,and the postoperative scores of both groups decreased significantly compared with those before surgery(P_(TKA-fore 1 month after surgery),P_(UKA-fore 1 month after surgery)<0.001).Compared with TKA,there was no significant difference in preoperative scores and scores at 6 months after operation.The scores of UKA patients 1 month and 3 months after surgery were significantly better than those of TKA patients(PTKA-fore 1 month after surgery,PUKA-fore 1 month after surgery<0.001,_(PTKA-fore 3 month after surgery)=0.004,P_(UKA-fore 3 month after surgery)=0.049).The postoperative score decrease 1 month after surgery and 3 months after surgery in UKA group was significantly higher than that in TKA group(P_(TKA-fore 1 month postoperative decrease),P_(UKA-fore 1 month postoperative decrease)<0.001,P_(UKA-fore 3 month postoperative decrease)=0.021),and there was no significant difference between the two surgical scores 3 months after surgery and 6 months after surgery(P_(TKA-fore 3 month postoperative decrease)=0.404,PTKA-fore 6 month PostoPerative decrease=0.471.P^(UKA-fore 6 month PostoPerative decrease)=0.640).When TKA was first performed,the postoperative Likert satisfaction was 84.2%for UKA and 89.5%for TKA.When UKA was advanced,the postoperative Likert satisfaction of the patients was 87.5%,and the difference in satisfaction was not statistically significant.The good recovery rate of the two types of surgery was 84.2%at TKA first and 87.5%at UKA first,with no statistical significance between the two groups(P>0.05).The comparison trend of all groups in TKA and UKA precursor groups was basically the same.Conclusions Both UKA and TKA achieve better postoperative functional recovery in the early postoperative period for patients with medial knee single compartment osteoarthritis,and UKA recoveres faster than TKA.Both methods achieve high patient satisfaction.