单髁置换术治疗中重度膝关节单间室骨关节炎  

Unicondylar knee arthroplasty for treatment of moderate-to-severe unicompartmental knee osteoarthritis

作　　者：郭马珑 崔宏勋[1] 李峰[1] 郭珈宜[1] 姚俊娜[1] 米豫飞[1] 郭艳幸[1] 

机构地区：[1]河南省洛阳正骨医院/河南省骨科医院,河南洛阳471002

出　　处：《中医正骨》2017年第6期16-19,27,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：河南省中医临床学科领军人才培育计划项目(HNZYLJ201301009);国家中医药管理局"平乐郭氏正骨流派传承工作室"建设项目(2012-228)

摘　　要：目的:探讨单髁置换术治疗中重度膝关节单间室骨关节炎的临床疗效。方法:2013年10月至2015年5月,共纳入中重度膝关节单间室骨关节炎患者60例,Kellgren-Lawrence分级Ⅲ级25例、Ⅳ级35例;随机分为2组,每组30例,分别采用单髁置换术和胫骨高位截骨术治疗。记录2组患者手术时间、术中出血量、术后下床时间及住院时间。分别于术前和术后12个月,采用疼痛视觉模拟量表(visual analogue scale,VAS)评分和Lysholm膝关节评分评价患者膝关节疼痛和功能情况。结果:2组患者均顺利完成手术。与胫骨高位截骨组相比,单髁置换组手术时间和住院时间较短、术中出血量少、术后下床早[(102.15±12.73)min,(125.79±16.26)min,t=29.762,P=0.046;(9.08±2.03)d,(24.02±3.82)d,t=37.285,P=0.031;(263.19±31.25)m L,(307.58±41.62)m L,t=49.193,P=0.026;(9.02±1.26)d,(67.56±9.64)d,t=76.183,P=0.021]。术前2组患者膝关节疼痛VAS评分及膝关节Lysholm评分组间比较,差异均无统计学意义[(8.54±0.86)分,(8.57±0.89)分,t=0.640,P=1.059;(58.42±5.39)分,(58.46±5.30)分,t=0.609,P=1.068];术后12个月,2组患者膝关节疼痛VAS评分均较术前降低[(1.56±0.35)分,(8.54±0.86)分,t=1.021,P=0.000;(3.07±0.61)分,(8.57±0.89)分,t=1.236,P=0.000],膝关节Lysholm评分均较术前增加[(90.28±5.05)分,(58.42±5.39)分,t=5.174,P=0.000;(83.97±6.19)分,(58.46±5.30)分,t=4.927,P=0.000],但2组患者膝关节疼痛VAS评分和膝关节Lysholm评分的组间差异均无统计学意义[(1.56±0.35)分,(3.07±0.61)分,t=2.045,P=0.189;(90.28±5.05)分,(83.97±6.19)分,t=7.617,P=0.165]。结论:与胫骨高位截骨术相比,单髁置换术治疗中重度膝关节单间室骨关节炎,手术时间和住院时间短、术中出血少、下床活动时间早。2种方法均有利于膝关节疼痛的缓解和膝关节功能的恢复,且疗效相当。Objective： To explore the clinical curative effects of unicondylar knee arthroplasty（ UKA） in the treatment of moderate-tosevere unicompartmental knee osteoarthritis（ KOA）. Methods： Sixty patients with moderate-to-severe unicompartmental KOA were included from October 2013 to May 2015 and were randomly divided into 2 groups,30 cases in each group. The patients were treated with UKA and osteotomy of proximal tibia（ OPT） respectively. According to Kellgren-Lawrence classification,the KOA belonged to gradeⅢ（ 25） andⅣ（ 35）. The operative time,intraoperative blood loss,bed rest time and hospital stay were recorded and compared between the 2 groups. The knee pain and function were evaluated by using visual analogue scale（ VAS） score and Lysholm knee score respectively before the surgery and at 12 months after the surgery. Results： The surgery were finished successfully in all patients. The operative time and hospital stay were shorter and the intraoperative blood loss was less and the bed rest time was shorter in UKA group compared to OPT group（ 102. 15 ＋/-12. 73 vs 125. 79 ＋/-16. 26 min,t = 29. 762,P = 0. 046; 9. 08 ＋/-2. 03 vs 24. 02 ＋/-3. 82 days,t = 37. 285,P = 0. 031; 263. 19 ＋/-31. 25 vs 307. 58 ＋/-41. 62 ml,t = 49. 193,P = 0. 026; 9. 02 ＋/-1. 26 vs 67. 56 ＋/-9. 64 days,t = 76. 183,P = 0. 021）. There was no statistical difference in knee pain VAS scores and Lysholm knee scores between the 2 groups before treatment（ 8. 54 ＋/-0. 86 vs 8. 57 ＋/-0. 89 points,t = 0. 640,P = 1. 059; 58. 42 ＋/-5. 39 vs 58. 46 ＋/-5. 30 points,t = 0. 609,P = 1. 068）. The knee pain VAS scores decreased in both of the 2 groups at 12 months after the surgery（ 1. 56 ＋/-0. 35 vs 8. 54 ＋/-0. 86 points,t = 1. 021,P = 0. 000; 3. 07 ＋/-0. 61 vs8. 57 ＋/-0. 89 points,t = 1. 236,P = 0. 000）. The Lysholm knee scores increased in both of the 2 groups at 12 month after the surgery（ 90. 28 ＋/-5. 05 vs 58. 42 ＋/-5. 39 points,t = 5. 174,P = 0. 000; 83. 97 ＋/-6. 19 vs 58.

关 键 词：骨关节炎 膝 关节成形术 置换 膝 截骨术 胫骨 

分 类 号：R687.4[医药卫生—骨科学]