单髁置换与胫骨高位截骨治疗膝关节内侧间室骨关节炎:1年随访比较

Comparison of one-year follow-up effectiveness between high tibial osteotomy and unicompartmental knee arthroplasty for treating medial compartment osteoarthritis of the knee

背景:膝关节内侧间室骨关节炎患者临床上经常会通过单髁置换或者胫骨高位截骨治疗,但选择胫骨高位截骨还是单髁置换更适合尚存争议。目的:探讨胫骨高位截骨与单髁置换治疗膝关节内侧间室骨关节炎的近期疗效。方法:纳入2016年5月至2017年8月收治的38例膝关节内侧间室骨关节炎患者,根据意愿原则分成2组,其中胫骨高位截骨组18例,单髁置换组20例。记录比较2组患者Tegner膝关节运动评分及Lysholm膝关节评分,评价关节功能恢复情况;根据膝关节负重位X射线片测定胫股角,评定膝关节各间室关节软骨退变情况。结果与结论:(1)术后2组患者手术切口均获得Ⅰ期愈合,并且均获得随访,胫骨高位截骨组随访时间为1.0-2.8年,单髁置换组为1.0-3.2年;(2)2组患者组内手术前后Tegner膝关节评分、Lysholm膝关节评分、胫股角比较,2组术后均能改善运动功能及矫正膝关节畸形,差异均有显著性意义(P <0.05);2组间各指标比较差异均无显著性意义(P> 0.05);(3)提示临床治疗膝关节内侧间室骨关节炎,无论是胫骨高位截骨还是单髁置换,均能获得满意的近期疗效,但中远期疗效有待进一步观察。

BACKGROUND: Patients with medial compartment osteoarthritis of the knee often receive unicompartmental knee arthroplasty or high tibial osteotomy treatment. However, which one is the optimal choice remains controversial.OBJECTIVE: To compare the short-term effectiveness of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of medial compartment osteoarthritis of the knee.METHODS: Thirty-eight patients with medial compartment osteoarthritis of the knee from May 2016 to August 2017 were enrolled. Eighteen patients were treated with high tibial osteotomy, and 20 patients were treated with unicompartmental knee arthroplasty. Tegner activity score and Lysholm knee score were compared to assess the functional recovery of knee joint. The femorotibial angle was measured on X-ray, and the cartilage degeneration of each compartment was evaluated.RESULTS AND CONCLUSION:(1) All incision healed primarily in both groups. All patients were followed up for 1.0-2.8 years in the high tibial osteotomy group and 1.0-3.2 years in the unicompartmental knee arthroplasty group.(2) There were significant differences in the Tegner activity score, Lysholm knee score, and femorotibial angle in the two groups before and after operation, showing that both groups could improve mobility function and correct deformity(P < 0.05). There was no significant difference in all above indexes between two groups(P > 0.05).(3) These results indicate that both high tibial osteotomy and unicompartmental knee arthroplasty can achieve good short-term effectiveness for treating medial compartment osteoarthritis of the knee;however, the long-term effectiveness needs further investigation.