老年骨关节炎单髁与全膝置换的比较

Unicompartmental knee arthroplasty versus total knee arthroplasty for medical compartment knee osteoarthritis in elderly

摘要:

[目的] 比较微创单髁置换术（unicompartmental knee arthroplasty, UKA） 与全膝置换术（total knee arthroplasty,TKA） 治疗老年内侧室骨关节炎（medial compartment knee osteoarthritis, MC-KOA） 的临床效果。[方法] 回顾性分析2021 年9月—2022 年9 月收治的109 例老年MC-KOA 患者的临床资料。根据医患沟通结果，59 例行UKA 术，另50 例行TKA 术。比较两组围手术期、随访及影像资料。[结果] UKA 组手术时间[(61.8±4.7) min vs (80.4±6.5) min, P＜0.001]、切口长度[(5.7±0.3) cmvs (6.9±0.4) cm, P＜0.001]、术中失血量[(94.3±13.1) ml vs (147.5±19.8) ml, P＜0.001]、术后引流量[(169.8±10.0) ml vs (366.7±41.1) ml,P＜0.001]、膝关节自主屈曲至90°时间[(13.8±2.2) d vs (17.1±2.4) d, P＜0.001] 及住院时间[(9.8±1.8) d vs (14.4±2.4) d, P＜0.001] 均显著少于TKA 组。随时间推移，两组VAS 评分、KSS 评分、膝伸-屈ROM、步速、步频及步幅均显著改善（P＜0.05）；末次随访时，UKA 组KSS 评分[(88.2±3.6) vs (82.7±3.1), P＜0.001]、膝伸-屈ROM [(123.9±5.7)° vs (116.4±5.1)°, P＜0.001]、步速[(98.4±5.3) cm/s vs(85.1±5.9) cm/s, P＜0.001]、步幅[(89.3±10.1) cm vs (80.1±11.2) cm, P＜0.001] 显著优于TKA 组。影像方面，随时间推移，两组末次随访时股胫角、髋-膝-踝角、胫骨近端内侧角、胫骨平台后倾角均显著改善（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] 老年MC-KOA 施行微创UKA 术与TKA 术均可获得满意的临床疗效，但UKA 术在减少手术创伤、促进膝关节功能恢复及改善步态方面更具优势。

Abstract:

[Objective] To compare clinical outcomes of unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty(TKA) for medial compartment knee osteoarthritis (MC-KOA) in the elderly. [Methods] A retrospective analysis was conducted on 109 el-derly patients who received knee arthroplasty for MC-KOA from September 2021 to September 2022. According to the preoperative doctorpatientcommunication, 59 patients underwent UKA, while other 50 patients underwent TKA. The perioperative, follow-up and imaging dataof the two groups were compared. [Results] The UKA group proved significantly superior to the TKA group in terms of operation time [(61.8±4.7) min vs (80.4±6.5) min, P＜0.001], length of incision, [(5.7±0.3) cm vs (6.9±0.4) cm, P＜0.001], intraoperative blood loss [(94.3±13.1) mlvs (147.5±19.8) ml, P＜0.001], postoperative drainage volume [(169.8±10.0) ml vs (366.7±41.1) ml, P＜0.001], time to regain active knee flex-ion of 90° [(13.8±2.2) days vs (17.1±2.4) days, P＜0.001], and hospital stay [(9.8±1.8) days vs (14.4±2.4) days, P＜0.001]. As time went on,the VAS and KSS scores, knee extension-flexion ROM, stride speed, stride frequency and stride length were significantly improved in bothgroups (P＜0.05). At the last follow-up, the UKA group was also significantly better than the TKA in terms of KSS score [(88.2±3.6) vs (82.7±3.1), P＜0.001], knee extension-flexion ROM [(123.9±5.7)° vs (116.4±5.1)°, P＜0.001], stride speed [(98.4±5.3) cm/s vs (85.1±5.9) cm/s, P＜0.001], stride length [(89.3±10.1)cm vs (80.1±11.2) cm, P＜0.001]. As for imaging, femorotibial angle (FTA), hip-knee-ankle angle (HKA),medial proximal tibial angle (MPTA) and posterior tibial slope (PTS) were significantly improved in both groups at the last follow-up com-pared with those preoperatively (P＜0.05). However, there were no significant differences in the above image indexes between the two groupsat any corresponding time points (P＞0.05). [Conclusion] Both UKA and TKA do achieve satisfactory clinical consequences for MC-KOA inelderly. In comparison, the UKA has more advantages in reducing surgical trauma, promoting functional recovery of knee joint and improvinggait over the TKA.