全膝关节置换术与单髁置换术治疗膝关节单间室骨关节炎的疗效比较

目的 比较全膝关节置换术(TKA)与膝关节单髁置换术(UKA)治疗膝关节单间室骨关节炎的临床疗效。方法 对2012年3月—2015年3月徐州医科大学附属医院骨科88例行TKA或UKA治疗单间室骨关节炎并获得随访患者的临床资料进行回顾性分析,依据不同手术方法分为TKA组48例(48膝)和UKA组40例(40膝)。采用美国特种外科医院(HSS)膝关节评分,评价疗效。比较两组患者手术时间、术中出血量、术后引流量,术后第1天、3天、1周血红蛋白水平和术后第3天血红蛋白较术前的下降量,以及末次随访时关节活动度和疗效。结果 两组患者手术顺利,88例患者获随访6~36个月,平均20.25个月。TKA组手术时间(85.77±7.61)min多于UKA组的(80.50±6.82)min,术中出血量(103.54±17.68)mL多于UKA组的(74.75±11.82)mL,术后引流量(420.21±68.80)mL多于UKA组的(241.75±53.05)mL,差异均有统计学意义(t=3.389、t'=8.787、t'=13.411,P值均＜0.01)。两组术前血红蛋白水平差异无统计学意义(P＞0.05);TKA组术后第1天、3天、1周血红蛋白均低于UKA组,术后第3天血红蛋白较术前的下降量高于UKA组,差异均有统计学意义(P值均＜0.05)。UKA组术后膝关节屈曲至90°所需时间为(7.33±3.02)d,短于TKA组的(12.63±3.10)d(t=8.086,P＜0.01);末次随访UKA组患者膝关节屈曲角度为116.98°±13.71°,大于TKA组的125.13°±15.95°(t=2.576,P＜0.01)。TKA组和UKA组HSS评分优、良、可、差者分别为25、19、3、1例和23、15、2、0例,其优良率分别为91.67%(44/48)和95.00%(38/40),差异无统计学意义(Z=0.603,P＞0.05)。两组患者中仅TKA组发生深静脉血栓1例,经介入治疗后痊愈;其余患者无手术并发症发生。结论 UKA与TKA治疗膝关节单间室骨关节炎均能获得满意的临床疗效,但UKA具有出血少、手术时间短、功能恢复快等优点。

Comparison of total knee arthroplasty and unicompartmental knee arthroplasty in patients with osteoarthritis of knee in single compartment

Objective To investigate the result of total knee arthroplasty (TKA) versus unicompartmental knee arthroplasty (UKA) in the treatment of isolated compartmental osteoarthritis of knee.Methods From March 2012 to March 2015, the clinical data of the single compartment osteoarthritis patients underwent TKA and UKA with follow-up were retrospectively studied. According to different surgical Methods, the TKA group contained 48 patients (48 knees),the UKA group contained 40 patients (40 knees). Patients evaluation focused on operative time, blood loss, postoperative drainage, the amount of postoperative 1d, 3d, 1w hemoglobin, the decline of postoperative 3 d hemoglobin and the last follow-up of motion and efficacy(Hospital for Special Surgery, HSS).Results The patients in the two groups were operated successfully. Eighty-eight patients were followed up from 6 to 36 months, an average of 20.25 months. The operation time of TKA group [(85.77±7.61)min] was longer than that in the UKA group [(80.50±6.82)min], the blood loss of TKA group[(103.54±17.68)mL] was more than that in the UKA group [(74.75±11.82)mL], the postoperative drainage of TKA group [(420.21±68.80)mL] was more than that in the UKA group [(241.75±53.05)mL], the differences were all statistically significant (t=3.389, t'=8.787, t'=13.411, all P values<0.01). The hemoglobin level before surgery of two groups had no significant difference (P>0.05), the amount of postoperative 1 d, 3 d, 1 week were more in UKA than TKA, and the amount of postoperative 3 d hemoglobin decreased were less in UKA than TKA, the differences were statistically significant (P<0.05). The dates of knees being able to flex >90°after operation were less in the UKA group[(12.63±3.10)d] than those in the TKA group[(7.33±3.02)d](t=8.086, P<0.01), the end of the follow-up of knee flexion was significantly greater in the UKA group(116.98°±13.71°) than that in the TKA group(125.13°±15.95°)(t=2.576,P<0.01). The HSS score of two groups rated excellent, good, fair, and poor were 25, 19, 3, 1 cases, and 23,15, 2, 0 cases, respectively. The excellent and good rates were 91.67% (44/48) and 95.00% (38/40), respectively, the difference was not statistically significant (Z=0.603, P>0.05). Only one case had deep vein thrombosis in TKA group, but recovered after intervention treatment. The remaining patients had no complications.Conclusions For the treatment of isolated compartmental osteoarthritis of knee, UKA can a chieve good Results as well as TKA, but it has less blood loss, shorter operative time and more rapid postoperative recovery than TKA.