单髁与全膝关节置换术治疗高龄患者的配对病例对照研究  

Paired study of unicompartmental versus total knee arthroplasty for aged knee osteoarthritis patients

作　　者：张启栋[1] 郭万首[1] 刘朝晖[1] 程立明[1] 王卫国[1] 岳德波[1] 张念非[1] 

机构地区：[1]中日友好医院骨关节外科,北京100029

出　　处：《中华关节外科杂志（电子版）》2017年第1期4-8,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的对照研究比较单髁关节置换术(UKA)与全膝关节置换术(TKA)治疗75岁以上高龄膝骨关节炎的临床疗效及风险差异,以期为临床工作提供依据。方法回顾性分析中日友好医院股骨关节外科2010年1月至2015年12月符合纳入标准连续收治的经UKA治疗的67例(67膝)75岁以上高龄膝骨关节炎患者的临床资料,与同期应用TKA治疗的65例(67膝)75岁以上高龄膝骨关节炎患者按1∶1配对,配对条件为性别及术侧相同,年龄相近,影像学病变程度相似。评估两种手术方式治疗75岁以上高龄膝骨关节炎患者的并发症、住院时间、输血、疼痛视觉模拟(VAS)评分、美国特种外科医院(HSS)评分、关节活动度等项目,应用SPSS 17.0统计软件采用配对t检验或2检验分析比较两者临床疗效及风险差异。结果 UKA组和TKA组患者年龄与随访时间间的差异无统计学意义;两组各失访2例,2例UKA和3例TKA因非手术相关疾病死亡。UKA组和TKA组术后住院时间分别为(7.1±1.1)d和(9.2±2.0)d,组间差异有统计学意义(t=-7.603,P<0.05)。术前两组血红蛋白相近;UKA术后血红蛋白(108.8±13.1)g/L,输血1例;TKA术后血红蛋白(90.0±15.7)g/L,输血61例。TKA组术后血红蛋白含量明显低于UKA组(t=7.544,P<0.05);TKA组术后输血比例明显高于UKA组(61/67 vs 1/67)。两组术前HSS评分、VAS评分、关节活动度无统计学差异;UKA组术后关节活动度优于TKA组,(123.5±9.1)°vs(120.1±9.3)°,组间差异有统计学意义(t=2.113,P<0.05);但两组HSS评分、VAS评分无统计学差异。TKA组的术后并发症:假体周围感染1例,切口并发症3例;心血管并发症10例;急性精神障碍11例;脑血管并发症3例;呼吸系统并发症3例;消化系统并发症3例;泌尿系统并发症9例。UKA组的术后并发症:心血管并发症3例;急性精神障碍2例;呼吸系统并发症2例;消化系统并发症1例;泌尿系统并发症2例。结论对于75岁以上高龄膝骨关节炎患者,�Objective To explore the outcomes and risks of unicompartmental knee arthroplasty（UKA） versus total knee arthroplasty（TKA） in the patients over 75 years old of knee osteoarthritis.Methods From Jan 2010 to Dec 2015,67 consecutive knee osteoarthritis over 75 years old were treated by UKA in the department of joint surgery,China Japan Friendship Hospital,and the other 67 patients were treated by TKA in the same period.All these patients were enrolled and matched with respect to age,gender and radiological grade of knee arthrosis.Major postoperative complications,the length of hospital stay,pain visual analogue score（VAS）,range of motion（ROM） and hospital for special surgery（HSS）score were evaluated by paired t test.Results The mean age and follow-up time were comparable between the two groups（P〉 0.05）.Two cases were lost during the follow-up in each group.Two cases of UKA and three cases of TKA died of causes not related to arthroplasty before the last follow-up.The preoperative VAS score,ROM and HSS score were not significant different between the two groups.In the UKA group,postoperative hospital-stay was（7.1 ± 1.1） days and in the TKA group it was（9.2 ± 2.0） days.There was significant difference between the two groups（t =-7.603,P〈 0.05）.The patients of the UKA group showed significantly higher mean postoperative ROM and hemoglobin level than the TKA group：ROM,（123.5 ± 9.1） ° vs（120.1 ± 9.3） °（t = 2.113,P 〈0.05）; hemoglobin,（108.8 ± 13.1） g/L vs（90.0 ± 15.7） g/L（t = 7.544,P 〈0.05）.The blood transfusion rate was significantly higher in the TKA group than the UKA group（61/67 vs 1/67）.The postoperative pain VAS score and HSS score were comparable between the two groups,（P〉 0.05）.One case developed infection and three cases developed incision complications in the TKA group.Cardiovascular complication developed in three cases of the UKA group and in 10 cases of the TKA group.Postoperative acute mental disorder occurred in two cases

关 键 词：单间室 关节成形术 置换 膝 骨关节炎 膝 老年人 

分 类 号：R687.4[医药卫生—骨科学]