内侧室骨关节炎单髁与全膝置换倾向评分匹配比较△

A propensityscore matching comparison of unicompartmental knee arthroplasty and total knee arthroplasty for medialcompartment osteoarthritis of the knee

摘要:

[目的] 比较单髁置换术（unicomparmental knee arthroplasty, UKA） 和全膝置换（total knee arthroplasty, TKA） 治疗膝内侧间室骨性关节炎的近期临床结果。[方法] 回顾性分析2021 年1 月—2023 年8 月本院关节置换治疗457 例膝内侧室骨性关节炎变患者的临床资料，采用PSM 匹配，最终纳入本研究的UKA 和TKA 患者各为88 例，比较两组围手术期、随访及影像资料。[结果] UKA 组手术时间[(74.6±8.1) min vs (85.4±8.7) min, P＜0.001]、切口长度[(7.1±0.9) cm vs (14.4±2.6) cm, P＜0.001]、术中失血量[(174.6±33.5) ml vs (305.7±68.9) ml, P＜0.001]、术后引流量[( 22.7±3.6) ml vs (43.5±6.7) ml, P＜0.001]、下地行走时间[(2.7±0.5) h vs (4.7±1.1) h, P＜0.001]、切口愈合等级[甲/乙/丙, (32/48/8) vs (21/48/19), P=0.034]、住院时间[(8.1±1.9) d vs (11.1±2.7) d, P＜0.001] 和治疗费用[(4.7±1.1) 万元vs (5.1±1.4) 万元, P=0.012] 均显著优于TKA 组。UKA 组患者恢复完全负重活动显著早于TKA 组（P＜0.05）。随时间推移，两组患者VAS、HSS、WOMAC 评分和ROM 均显著改善（P＜0.05）。术后1 个月和末次随访时，UKA 组的VAS、HSS、WOMAC 评分和ROM 均显著优于TKA 组（P＜0.05）。但是，两组间远期并发症发生率的差异无统计学意义（P＞0.05）。辅助检查方面，术后1 个月时，UKA 组滑液TNF-α、TGF-β1 水平均显著优于TKA 组（P＜0.05）。末次随访时， UKA 组的FTA、MPTA、PTS及MAD 均优于TKA 组（P＜0.05）。[结论] 对膝内侧间室骨性关节炎，UKA 的手术创伤更小，近期临床结果优于TKA。

Abstract:

[Objective] To compare the short-term clinical outcomes of unicompartmental knee arthroplasty (UKA) versus total knee ar-throplasty (TKA) for medial compartment osteoarthritis of the knee. [Methods] A retrospective analysis was performed on 457 patients whoreceived arthroplasty for medial compartment osteoarthritis of the knee in our hospital from January 2021 to August 2023. By propensityscorematching (PSM) method, 88 patients underwent UKA and 88 received TKA were finally included in this study. The document regard-ing perioperative period, follow-up and auxiliary examinations were compared between the two groups. [Results] The UKA group proved sig-nificantly superior to the TKA group in terms of operation time [(74.6±8.1) min vs (85.4±8.7) min, P＜0.001], incision length [(7.1±0.9) cm vs(14.4 + 2.6) cm, P＜0.001], intraoperative blood loss [(174.6 ±33.5) ml vs (305.7± 68.9) ml, P＜0.001], postoperative drainage [(22.7±3.6) mlvs (43.5±6.7) ml, P＜0.001], ambulation time [(2.7±0.5) hours vs (4.7±1.1) hours, P＜0.001], as well as incision healing grade, hospital stayand treatment cost. In addition, the patients in UKA group resumed full weight-bearing activities significantly earlier than those in TKAgroup (P＜0.05). The VAS, HSS, WOMAC scores and ROM significantly improved in both groups over time (P＜0.05). The UKA was signifi-cantly better than the TKA group regarding to VAS, HSS, WOMAC score and ROM 1 month postoperatively and at the last follow-up (P＜0.05). However, there was no significant difference in the incidence of later complications between the two groups (P＞0.05). As for auxiliaryexamination, the UKA group was also significantly better than the TKA group in terms of the levels of TNF-α and TGF-β1 in synovial fluid1 month after surgery (P＜0.05). At the last follow-up, the UKA group got significantly better femorotibial angle (FTA), medial proximal tibialangle (MPTA), posterior tibial slope (PTS) and mechanical axis deviation (MAD) on images than the TKA group (P＜0.05). [Conclusion] Formedial compartment osteoarthritis of the knee, UKA is less invasive and has better short-term clinical outcomes than TKA.