单髁置换与全膝关节置换治疗膝关节单室骨性关节炎为主的早中期疗效比较

目的 探讨小切口单髁置换术与全膝关节置换治疗膝关节单室骨性关节炎为主的早期临床的手术疗效的比较.方法 回顾性分析2003年1月至2009年4月小切口单髁置换术及全膝关节置换术,均由一位主任医帅完成,所有两组的患者的选择都满足于下例条件:(1)患者50岁以上,仅有膝关节内侧部位疼痛.(2)X线显示内侧单室膝关节骨关节炎为主,Ahlback X线分级Ⅰ～Ⅲ期;髌-股骨关节的Ahlback X线分级0～Ⅰ期,没有髌股关节的症状;膝内翻＜15°;膝关节屈曲畸形＜10°.(3)关节稳定(术中验证前、后交叉韧带完整).48例(48膝)经小切口单髁置换术治疗的膝关节单间室骨性关节炎患者,年龄52～71岁,平均67.5岁,体重指数21.1～32.7.全膝关节置换组,年龄53～76岁,平均67.2岁,体重指数21～32.4.对患者术前、后膝关节疼痛与关节活动度进行评估(HSS评分).结果 术后平均随访52.4个月(12～82个月),48膝单髁置换术后关节负重内侧间室疼痛减轻或消失,膝屈曲度平均达104°,优良率与全膝置换术相似;髌股关节退变(0～1期)与疗效无关;3例髌股关节退变由Ahlback X线分级0期进展到Ⅰ期,未有长期膝前痛发生;BMI(25～32)组与BMI(21～25)组的早中期的疗效差异无统计学意义.结论 小切口单髁置换术治疗膝关节骨性关节炎近中期疗效满意,具有创伤小、恢复快、症状改善明显等特点,没有症状的轻度髌-股骨关节退变及超重体重因素(BMI＜32)不影响近中期疗效.

Comparison of short-median term outcome between total knee arthroplasty and unicondylar arthroplasty in patients with osteoarthritis affected with medial compartment mainly of the knee

Objective To explore the short and mid-term outcome and surgical technique of minimally invasive unicondylar knee arthroplasty (UKA) for osteoarthritis affected with medial compartment predominantly of the knee. Methods From January 2003 to April 2009, all operations were performed by a senior surgeon. All patients followed the following criteria: (1) More than 50 years old and symptoms concentrated on the medial side of knee; (2) Osteoarthritis characterized mainly by medial compartment on X-rays and staged Ⅰ -Ⅲ by Ahlback staging system. There was no symptom of patellofemoral joint. Varus deformity was less than 15 degrees and flexious deformity less than 10 degrees; (3) Knee joint was stable with intact main ligaments. Methods Forty-eight patients (48 knees) with osteoarthritis of the knee undergone UKA by minimally invasive surgery. The patients included 9 males and 39 females with an age range of 52-71 years old and a body mass index of 21.1-32. 7. And 52 matched patients included 9 males and 39 females aged from 53 to 76 years old and with a body mass index of 21-32.4 undergone TKA. The pain and range of motion ( ROM ) of knees were evaluated by HSS score system before and after UKA and TKA. Results All patients were followed up for an average of 52.4 months (range:12-82). In UKA group,all patients received pain relief and there was no continuous anterior knee pain. The range of motion of knee reached a median of 126 degrees and obtained a postoperative HSS score of 96 versus a preoperative score of 62. The rate of excellent and good outcome approached 97%. The results were similar in TKA group. However, in UKA group, the patients had a lesser blood loss, a faster recovery and a lower cost than those in TKA group. Conclusion The short and mid-term outcome of UKA for osteoarthritis of knee affected with medial compartment is satisfactory. UKA is minimally invasive and has a faster recovery. Mild asymptomatic degeneration of patellofemoral joint and over-weight ( BMI ＜32) do not affect the short and mid-term outcome.