三种术式治疗膝骨关节炎的凝血与临床比较△

Effect of three surgical procedures for knee osteoarthritis on coagulation and clinical outcomes

摘要:

［目的］ 比较胫骨高位截骨术 （high tibial osteotomy, HTO）、单髁置换术 （unicompartmental knee arthroplasty, UKA） 及全膝置换术 （total knee arthroplasty, TKA） 治疗膝骨关节炎 （knee osteoarthritis, KOA） 的凝血和临床效果。［方法］ 回顾性分析 2015 年 1 月—2018 年 12 月本院治疗的 99 例内侧间室 KOA 患者的临床资料。依据术前医患沟通结果，34 例采用 HTO，33 例采用 UKA，32 例采用 TKA。比较凝血-纤溶系统检测和临床结果。［结果］与术前相比，术后 1d 三组和 PT、APTT、FDP、 D-D 均显著升高（P<0.05）；术后 7 d 又下降至术前水平（P>0.05）。术后 1 d，PT、APTT、FDP 和 D-D 由低至高均依次为：UKA 组0.05）。［结论］三种术式治疗内侧间室 KOA 的中远期疗效相当，但 UKA 近期疗效优于 HTO 和 TKA，且对凝血系统影响小。

Abstract:

[Objective] To compare the effects of high tibial osteotomy (HTO) , unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) on coagulation fibrinolytic system and clinical outcomes for knee osteoarthritis (KOA) . [Methods] A retrospective study was conducted on 99 patients who received surgical treatment for medial KOA in our hospital from January 2015 to December 2018. According to preoperative doctor-patient communication, 34 patients received HTO, 33 patients underwent UKA, and 32 patients were treat- ed with TKA. The documents regarding to coagulation-fibrinolytic system and clinical consequences were compared. [Results] Compared with those preoperatively, the PT, APTT, FDP and D-D significantly increased in all the three groups 1 day after operation (P<0.05) , and then returned to the preoperative level at 7 days after operation (P>0.05) . At 1 day after operation, PT, APTT, FDP and D-D were ranked from low to high in the following order: UKA group < HTO group HTO group > TKA group, with statistically significant differences (P<0.05) , whereas which became not statistically significant among the three groups at 2 years after operation (P>0.05) . [Conclusion] The three surgical procedures for treatment of medial compartment KOA is comparable in the middle and long-term outcomes, however, the UKA is better than HTO and TKA in short-term outcomes with little impact on the coagulation system.