单髁置换术与全膝关节置换术治疗膝单间室骨性关节炎近中期疗效的对比研究

目的探讨膝单髁置换术(UKA)和全膝关节置换术(TKA)治疗膝单间室重度骨性关节炎(KOA)的近中期临床疗效。方法随访本研究中因患膝单间室重度KOA接受单髁置换术的患者23例(23膝),同时期同术者施行的全膝关节置换术50例(56膝)。UKA组23位患者22名获得到了较为完整的临床随访,1例死亡。平均时间为28.6个月(4个月～7年),TKA组50位患者均获得随访,平均时间为32.9个月(2个月～7年)。对手术前后HSS评分,疼痛缓解,术中出血量及术后3d血红蛋白下降量,关节屈曲大于90°时间及屈曲大于120°膝关节数进行比较。结果UKA组与TKA组均获得满意疗效,两组患者均无假体松动,无关节翻修等严重并发症,HSS评分UKA组术前(64±5.75)分,术后末次随访(86±7.85)分(t=11.53,P0.001);TKA组术前(61±6.53)分,术后末次随访(84±7.92)分(t=18.64,P0.001)。与TKA组比较,UKA组术中出血(t=12.47,P0.001)及术后3d天血红蛋白下降少(t=13.61,P0.001),疼痛缓解相似(2=0.007,P0.05),术后膝关节屈曲到90°时间短(t=3.97,P0.05),术后能屈曲到120°的比率高。结论在严格掌握适应证的前提下,对于膝单间室重度KOA患者的手术治疗,UKA的近中期疗效可与TKA相媲美,而且UKA具有创伤小,出血少,患者耐受性好,术后恢复快的优点。

Unicompartmental knee arthroplasty versus totle knee arthroplasty:early and medium results of the treatment for isolated compartmental knee osteoartheitis

Objective To investigate the early and medium term result of unicompartmental knee arthroplasty （UKA） versus totle knee arthroplasty （TKA） for the treatment of isolated compartmental osteoarthritis of knee. Methods The UKA group contained 23 patients （23 knees） and 50 patients were in TKA group （56knees）. All the patients accepted arthroplasty during Feb 2002-Dec 2008. 12 at The Second Hospital of Xiang Ya Medical College by the same operator. 22 patients of UKA group were followed up for 4 months-7 years, average18.6 months, and the other one died 2 years after the operation. All patients of TKA group were followed up for 2 months-7 years,average 22.9 months. Patients evaluation focused on questionnair （HSS）, blood loss, pain relief, the term of knee flexing to 90°, the number of knee being able to flex ≥ 120°. All the results were compared and analyzed. Results Therapeutic effects of both two groups appeared excellent. There were no component loosening and revision. HSS knee score improved significantly in both two groups： UKA group was promoted from （64±5.75） to （86±7.85） （t=11.53, P0.001） and TKA group from （61±6.53） to （84±7.92） （t=18.64, P0.001）. Compared with the TKA group, the UKA had less blood loss （t=12.47, P0.001）, the same relief from pain（X2=0.007, P0.05）. The dates of knees being able to flex ≥ 90° afte operation were less （t=3.97, P0.05） while the number of knees being able to flex ≥ 120° were higher in the UKA group and there were more excellent and good cases in this group. Conclusions Our study indicated that, with the strict indications selection, UKA for the treatment of isolated compartmental osteoarthritis of knee shows as well as TKA, and it is less trauma, less blood loss, more rapid postoperative recovery than TKA, at least in the early and medium term.