内侧室膝骨关节炎活动与固定平台单髁置换比较

Movable bearing versus fixed bearing prostheses in unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee

摘要:

[目的] 探讨活动平台（mobile bearing, MB） 和固定平台（fixed bearing, FB） 行膝关节单髁置换术（unicompartmen-tal knee arthroplasty, UKA） 治疗内侧室膝关节骨关节炎（knee osteoarthritis, KOA） 的临床疗效。[方法] 回顾性分析本院2020年1 月—2023 年1 月行UKA 治疗的102 例的内侧室KOA 患者的临床资料。根据术前医患沟通结果，54 例采用MB 假体，48例采用FB 假体。对比两组围手术期、随访及影像指标。[结果] 所有患者均顺利完成手术，两组手术时间、切口长度、术中失血量、术后引流量、下地行走时间与住院时间的比较差异均无统计学意义（P＞0.05）。但MB 组治疗费用显著少于FB 组[(5.1±0.2)万元vs (5.5±0.3) 万元, P＜0.001]。随访时间平均（26.5±3.0） 个月。两组完全负重活动时间的差异无统计学意义（P＞0.05）。术后随时间推移，两组VAS 评分、WOMAC 评分、HSS 评分与膝伸屈ROM 均显著改善（P＜0.05）。相应时间点，两组间上述指标的差异均无统计学意义（P＞0.05）。与术前相比，末次随访两组股胫角（femorotibial angle, FTA）、髋-膝-踝角（hip-knee-ankle, HKA）、内侧胫骨近端角（medial proximal tibial angle, MPTA） 均显著改善（P＜0.05）；胫骨平台后倾角（posterior tibial slope, PTS） 无显著变化（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] MB 与FB 行UKA 治疗内侧室KOA 疗效相当。

Abstract:

[Objective] To compared the clinical outcome of mobile bearing (MB) and fixed bearing (FB) platforms in unicompartmentalknee arthroplasty (UKA) in the treatment of medial compartment osteoarthritis of the knee. [Methods] A retrospective study was conductedon 102 patients who received UKA for medial compartment osteoarthritis of the knee in our hospital from January 2020 to January 2023. Ac-cording to preoperative doctor-patient communication, 54 patients received MB prosthesis and 48 patients received FB prosthesis. The peri-operative period, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had UKA performed suc-cessfully with no significant differences in operation time, incision length, intraoperative blood loss, postoperative drainage volume, walkingtime and hospital stay between the two groups (P＞0.05). However, the treatment cost in MB group was significantly lower than that in FBgroup [(5.1±0.2) 10k yuan vs (5.5±0.3) 10k yuan, P＜0.001]. The mean follow-up time was of (26.5±3.0) months, and there was no significantdifference in the time to regain full weight-bearing activities between the two groups (P＞0.05). The VAS score, WOMAC score, HSS scoreand extension-flexion range of motion (ROM) were significantly improved in both groups over time postoperatively (P＜0.05), whereas whichwere not statistically significant between the two groups at any corresponding time points (P＞0.05). As for imaging, femorotibial angle (FTA),hip-knee-ankle (HKA) and medial proximal tibial angle (MPTA) were significantly improved in both groups at the latest follow-up com-pared with those preoperatively (P＜0.05), whereas there were no significant changes in posterior tibial slope (PTS) (P＞0.05). At any timepoints accordingly, there were no significant differences in the above image indicators between the two groups (P＞0.05). [Conclusion] TheMB UKA and FB UKA achieve comparable clinical consequences for medial compartment osteoarthritis of the knee.