单髁与后交叉韧带保留型假体膝关节置换的近期疗效对比

文题释义：单髁置换：指对仅存在单间室病变膝关节的一种置换手术方式，用以替代膝关节胫股关节破坏的软骨表面，具有微创手术的优势，例如创伤小、恢复快、截骨少、费用低、手术时间短等优点。理论上，单髁置换后患者的膝关节活动度较好，且膝关节功能接近生理状态。后交叉韧带保留型假体：全膝关节置换术中一种较为成熟的假体，术中保留了膝关节后交叉韧带且不进行髁间窝截骨，比较符合膝关节的解剖特性，手术难度虽然较大，但保留了较多的膝关节正常生理结构，有较好的膝关节稳定性，假体的松动率亦较低。背景：针对仅存在膝关节内侧间室病变的患者，单髁置换与后交叉韧带保留型全膝关节置换均是有效的治疗方式，但对于居住于山区的中老年人的近期疗效需进一步探索。目的：探讨单髁置换与后交叉韧带保留型假体置换治疗承德地区中老年人膝关节内侧间室骨关节炎的近期疗效。方法：选择2017年1月至2019年2月在承德医学院附属医院关节外科接受手术治疗的内侧间室膝关节炎中老年患者67例，其中A组31例行单髁置换，B组36例行后交叉韧带保留型假体全膝置换。所有患者对治疗方案均知情同意，且得到医院伦理委员会批准。观察比较2组患者术中出血量、术后输血情况、术后血红蛋白下降值，术后1，3 d红细胞容积、C-反应蛋白，术后第1，3，6个月及1年的关节遗忘评分。结果与结论：①A组围术期血红蛋白下降值、术中出血量、输血率均低于B组，术后住院时间短于B组，差异有显著性意义(P < 0.05)；②术后第1，3天2组的C-反应蛋白水平差异无显著性意义(P > 0.05)；③A组术后第1，3，6月及1年的关节遗忘评分均高于B组，差异有显著性意义(P < 0.01)；④2组术后均未发生下肢深静脉血栓、肺栓塞及感染等并发症；⑤综上，单髁置换在治疗仅存在内侧间室病变膝关节炎的山区中老年患者时，具有术中出血少、输血率低、关节遗忘程度高等优点。ORCID: 0000-0002-8983-8293(韩梦光)中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Comparison of short-term outcomes between unicompartmental knee arthroplasty and posterior cruciate ligament-retaining total knee arthroplasty

BACKGROUND:Unicompartmental knee arthroplasty and posterior cruciate ligament-retaining total knee arthroplasty are effective for people who were subjected to medial compartment lesions of the knee;however,the short-term effect of middle-aged and elderly people living in mountainous area needs further exploration.OBJECTIVE:To investigate the short-term efficacy of unicompartmental knee arthroplasty and posterior cruciate ligament-retaining total knee arthroplasty in middle-aged and elderly people with medial compartment osteoarthritis of knee joint in Chengde.METHODS:A total of 67 middle-aged and elderly patients with medial compartment osteoarthritis of the knee were selected from January 2017 to February 2019 in the Department of Joint Surgery,Affiliated Hospital of Chengde Medical College.Totally 31 patients in group A were treated with unicompartmental knee arthroplasty and 36 patients in group B were treated with posterior cruciate ligament-retaining total knee arthroplasty.All patients signed the informed consent.This study was approved by the Hospital Ethics Committee.Intraoperative blood loss,postoperative blood transfusion,postoperative hemoglobin decline,hematocrit and C-reactive protein at postoperative 1 and 3 days,and Forgotten Joint Scores at 1,3,and 6 months and 1 year after surgery were observed and compared between the two groups.RESULTS AND CONCLUSION:(1)The perioperative hemoglobin decline,intraoperative blood loss,and blood transfusion rate were significantly lower,and postoperative hospitalization date was significantly shorter in group A than those in group B(P<0.05).(2)There was no significant difference in C-reactive protein between the two groups at 1 and 3 days after operation(P>0.05).(3)The Forgotten Joint Scores in group A were significantly higher than those in group B at 1,3,and 6 months and 1 year after operation(P<0.01).(4)No complications such as lower extremity venous thrombosis,pulmonary embolism and infection occurred in both groups.(5)In summary,unicompartmental knee arthroplasty has the advantages of less intraoperative bleeding,lower transfusion rate,and higher degree of Forgotten Joint Scores for the middle-aged and elderly patients with medial compartment lesions in mountainous areas.