膝内侧室骨性关节炎单髁置换60岁上下比较△

Comparison of unicompartmental knee arthroplasty for anteromedial osteoarthritis between patients older and younger than 60 years old

摘要:

[目的] 比较 60 岁上下患者接受膝关节单髁置换术 （unicompartmental knee arthroplasty, UKA） 后临床效果的差异， 并深入讨论 Oxford UKA 的理想适应证。[方法] 回顾性分析 2014 年 3 月—2017 年 12 月本院收治的 112 例因膝骨关节炎 （Os- teoarthritis, OA）初次接受 UKA 手术患者的临床资料。按患者手术时年龄分为两组：＜60 岁组和≥60 岁组，每组 56 例。比较两组围手术期、随访及影像资料。[结果]两组患者均顺利完成手术，无严重并发症，两组手术时间、手术切口总长度、术中失血量、下地行走时间、切口愈合等级和住院时间的差异均无统计学意（P＞0.05）。所有患者随访（69.2±5.3）个月，两组恢复完全负重活动时间的差异无统计学意义（P＞0.05）。术后随着时间推移，两组患者 VAS 评分显著减少（P＜0.05），而 HSS 评分、KSS 临床和功能评分及膝伸屈 ROM 显著增加（P＜0.05）。两组术前和术后 6 个月上述指标的差异均无统计学意义（P＞0.05）；末次随访两组膝关节 VAS 评分、HSS 评分、KSS 功能评分及膝伸屈 ROM 的差异均无统计学意义（P＞0.05），但＜60 岁组患者 KSS 临床评分显著优于≥60 岁组（P＜0.05）。影像方面，与术前相比，末次随访时，两组患者 FTA 角、mLDFA 角、mMPTA 角均显著改善（P＜ 0.05）。相应时间点，两组间上述影像指标的差异均无统计学意义（P＞0.05）。[结论] 在至少 5 年的随访中，＜60 岁组患者接受 Oxford UKA 后显示出良好的临床效果，但与≥60 岁组患者的功能效果没有显著差异。

Abstract:

[Objective] To compare the clinical outcomes of Oxford unicompartmental knee arthroplasty (UKA) between patients older and younger than 60 years, and to discuss the ideal indications of Oxford UKA. [Methods] A total of 112 patients who received primary UKA for knee osteoarthritis (KOA) from March 2014 to December 2017 were retrospectively reviewed. The patients were divided into two groups according to age at surgical procedure, the ＜60 group and the ≥60 group, with 56 cases in each group. The data regarding to perioperative pe- riod, follow-up and radiographs were compared between the two groups. [Results] All patients in both groups had UKA performed success- fully without serious complications. There were no significant differences in operation time, total length of surgical incision, intraoperative blood loss, time to walk down the ground, grade of incision healing and hospital stay between the two groups (P＞0.05). All patients were fol- lowed up for (69.2±5.3) months on an average, and there was no a significant difference in the time to resume full weight-bearing activities between the two groups (P＞0.05). As time went by, the VAS score was significantly decreased (P＜0.05), while HSS score, KSS clinical and functional scores and knee extension-flexion range of motion (ROM) significantly increased in both groups (P＜0.05). There was no signifi- cant difference in the above items between the two groups before surgery and 6 months after surgery (P＞0.05). The ＜60 group got significant- ly higher KSS clinical score than the ≥60 group at the latest follow-up (P＜0.05), despite that there were no significant differences in knee VAS score, HSS score, KSS functional score and knee ROM between the two groups (P＞0.05). Regarding imaging, femorotibial angle (FTA), mLDFA angle and mMPTA angle significantly improved postoperatively compared with those preoperatively in both groups (P＜0.05), which proved not statistically significantly different at any corresponding time points between the two groups (P＞0.05). [Conclusion] Patients re- ceiving Oxford UKA in age under 60 years show better clinical outcomes in at least 5 years of follow-up, although there was no considerably difference in functional outcomes with those aged ≥60 years.