微创小切口技术在膝关节内侧胫股间室骨关节炎治疗中的应用

目的 了解微创小切口技术方法治疗膝关节内侧胫股间室骨关节炎的临床疗效.方法 自2007年10月至2010年6月,对22例(25膝)内侧胫股间室重度骨关节炎患者经关节镜探查后,采用微创小切口技术行sledge knee假体UKA手术,并与同期进行的19例(21膝)Gemini MKⅡ假体全膝关节置换术(TKA)治疗组相比较.结果 两组术前一般资料比较,差异均无统计学意义(均P＞0.05).与TKA组相比,UKA组的术中出血量更少[(148±26)ml比(278±36) ml],手术时间更短[(68±12) min比(86±12)min],而且患膝关节屈曲达90°的康复进程更快[(3.1±1.8)d比(9.1±2.2)d],首次下床的时间更早[(2.1±1.0)d比(3.8±1.0)d,(P＜ 0.05)].患者术后随访时间为6 ～ 34个月.末次随访时两组的KSS膝评分、KSS功能评分及WOMAC评分相比,差异均无统计学意义(均P ＞0.05).结论 与TKA治疗膝关节内侧胫股间室骨关节炎相比,关节镜技术与小切口UKA相结合的疗法组织创伤更小,关节功能康复更快;二者的中期临床疗效无明显差异.

Comparison of efficacies for two surgical methods in the treatment of medial tibial-femoral osteoarthritis

Objective To compare the clinical efficacies of two surgical methods in the treatment of medial tibil-femoral osteoarthritis.Methods Between October 2007 and June 2010,a total of 22 cases (25 knees) with severe osteoarthritis in medial tibial-femoral compartment underwent minimally invasive unicompartmental knee arthroplasty (UKA) with Sled prosthesis after arthroscopic procedure. And its clinical efficacy was compared with that of 22 cases ( 25 knees) undergoing total knee arthroplasty (TKA)with Gemini MK Ⅱ prosthesis almost simultaneously. Results There were no significant difference in general data between 2 groups( P ＞ 0.05 ).Compared with the TKA group,the UKA group had a smaller blood loss (( 148 ±26) vs (278 ±36) ml),a shorter operative duration ((68 ± 12) vs (86± 12) min),a faster progress of resuming 90 ° flexation ( (3.1 ± 1.8 ) vs (9.1 ± 2.2) d) and an earlier off-bed time ( P ＜0.05).All patients were followed up for 6 - 34 months.There was no significant difference in KSS ( Knee Society Score),function score or WOMAC (Western Ontario and McMaster Universities) score between 2 groups at the last follow-up( P ＞ 0.05 ).Conclusion The treatment of medial tibial-femoral osteoarthritis with minimally invasive UKA is superior to that with TKA in that it is less invasive,there is a faster recovery of joint functions and no significant difference exists in the mid-term clinical efficacies between them.