膝内侧室骨性关节炎全膝与单髁置换早期结果比较△

Comparison of short-term outcomes of total knee arthroplasty versus unicompartmental knee arthroplasty for medial com⁃ partment osteoarthritis of the knee

摘要:

［目的］ 比较全膝关节置换术 （total knee arthroplasty, TKA） 和单髁置换术 （unicompartmentalknee arthroplasty, UKA） 治疗单纯性膝内侧间室骨性关节炎患者的临床效果。［方法］2017 年 1 月—2020 年 1 月，277 例单纯膝内侧间室骨性关节炎纳入本研究。依据术前医患沟通结果，156 例采用 TKA 术，121 例采用 UKA 术。比较两组患者围手术期、随访及影像资料。［结果］ UKA 组手术时间、切口长度、术中失血量及住院时间均显著优于 TKA 组 （P<0.05）。随访 12 个月以上，术后随时间推移，两组患者 VAS 及 WOMAC 评分均显著减少 （P<0.05），而 ROM 和 HSS 评分显著增加 （P<0.05）。术后 3 个月，UKA 组的 HSS、VAS、WOMAC 评分及 ROM 均显著优于 TKA 组 （P<0.05），但末次随访时，两组上述指标的差异均无统计学意义 （P> 0.05）。影像学方面，与术前相比，末次随访时 TKA 组的 FTA 显著减小 （P<0.05），而 UKA 组的 FTA 无显著变化 （P>0.05）； 两组 MPTA 均显著增加 （P<0.05），而 PTS 均显著减小 （P<0.05）。末次随访时 TKA 组 FTA 和 PTS 显著小于 UKA 组 （P< 0.05），而 MPTA 显著大于 UKA 组 （P<0.05）。［结论］ 从短期疗效来看，UKA 较 TKA 具有创伤更小、疼痛缓解更明显以及膝关节功能恢复更好等优点。

Abstract:

[Objective] To compare the clinical results of total knee arthroplasty (TKA) versus unicompartmental knee arthroplasty (UKA) for medial compartment osteoarthritis of the knee. [Methods] From January 2017 to January 2020, 277 patients with simple medial compartment osteoarthritis of the knee were enrolled in this study. According to the results of preoperative doctor-patient communication, 156 patients were treated with TKA, while other 121 patients received UKA. The perioperative, follow-up and imaging data were compared between the two groups. [Results] The UKA group proved significantly superior to the TKA in terms of operative time, incision length, in- traoperative blood loss and hospital stay (P＜0.05) . At the latest follow up lasted more than 12 months, the VAS and WOMAC scores de- creased significantly (P＜0.05) , whereas the ROM and HSS scores significantly increased in both groups compared with those before sur- gery (P＜0.05) . The HSS, VAS, WOMAC score and ROM in UKA group were significantly better than those in TKA group at 3 months post- operatively (P＜0.05) , while which became not statistically significant between the two groups at the latest follow-up (P＜0.05) . In terms of imaging assessment, the femorotibial angle (FTA) reduced significantly in the TKA group at the last follow-up compared with that before surgery (P＜0.05) , while which remained unchanged in the UKA group (P＜0.05) . However, the medial proximal tibial angle (MPTA) in- creased significantly (P＜0.05) , whereas the posterior tibial slope (PTS) significantly decreased in both groups at the latest follow up com- pared with those before operation (P＜0.05) . At the latest follow up the FTA and PTS in TKA group were significantly less than those in UKA group (P＜0.05) , while the MPTA in TKA group was significantly greater than that in the UKA group (P＜0.05) . [Conclusion] In terms of short-term efficacy, UKA has the advantages of less trauma, more obvious pain relief and better recovery of knee function over TKA.