同期和分期人工单髁关节置换治疗双膝前内侧骨关节炎的早期疗效和安全性比较  

Comparison of early effectiveness and safety of simultaneous and staged bilateral unicompartmental knee arthroplasty for bilateral anteromedial compartment osteoarthritis

作　　者：粟智远 刘俊才 邓翔天 敖彧农 魏代清 罗芸[2] 李忠 SU Zhiyuan;LIU Juncai;DENG Xiangtian;AO Yunong;WEI Daiqing;LUO Yun;LI Zhong(Department of Orthopaedics and Joint Surgery,the Affiliated Hospital of Southwest Medical University,Luzhou Sichuan,646000,P.R. China;Department of Neurology,Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital,Chengdu Sichaun,610072,P.R.China)

机构地区：[1]西南医科大学附属医院骨与关节外科,四川泸州646000 [2]四川省医学科学院,四川省人民医院神经内科,成都610072

出　　处：《中国修复重建外科杂志》2019年第7期854-859,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省教育厅科研课题(18ZA0533);四川省卫生和计划生育委员会科研课题(16PJ549)~~

摘　　要：目的比较同期和分期人工单髁关节置换(unicompartmental knee arthroplasty,UKA)治疗双膝前内侧骨关节炎的早期疗效及安全性。方法回顾性分析2015年1月-2017年1月完成双侧UKA的31例双膝前内侧骨关节炎患者临床资料。其中,17例行同期双膝UKA(同期组),14例行分期UKA(分期组)。两组患者性别、年龄、体质量指数、骨关节炎分级以及术前髋-膝-踝角、膝关节学会评分系统(KSS)评分、疼痛视觉模拟评分(VAS)、膝关节活动度等一般资料比较,差异均无统计学意义(P>0.05)。记录手术时间、出血量、住院时间、术后10 d内血红蛋白最低值及住院费用,分期组以两次手术总和进行比较。术后3、6、12个月,采用KSS评分、VAS评分、膝关节活动度评价手术疗效,并记录术后12个月患者满意度评分。结果同期组手术时间、住院时间及住院费用均低于分期组(P<0.05),两组出血量及术后10 d内血红蛋白最低值比较差异无统计学意义(P>0.05)。术后分期组1例(7.1%)1侧膝关节切口出现浅表感染,同期组1例(5.9%)出现谵妄,两组术后并发症发生率比较差异无统计学意义(P=1.000)。两组患者均获随访,随访时间12~32个月,平均24.7个月。两组术后3个月KSS评分比较差异无统计学意义(t=0.896,P=0.392),术后6、12个月同期组KSS评分明显高于分期组,差异有统计学意义(P<0.05)。两组术后3、6、12个月膝关节活动度、VAS评分比较差异均无统计学意义(P>0.05)。术后12个月同期组患者满意度评分明显高于分期组,差异有统计学意义(t=2.959,P=0.006)。X线片复查示假体均无松动。结论同期双侧UKA安全性与分期手术相似,但膝关节功能恢复更好、住院时间及手术费用均减少,患者满意度更高。Objective To compare the early effectiveness and safety of simultaneous bilateral and staged bilateral unicompartmental knee arthroplasty(UKA) in treatment of anteromedial compartment osteoarthritis. Methods The clinical data of 31 patients with bilateral anteromedial compartment osteoarthritis who underwent bilateral UKAs between January 2015 and January 2017 was retrospectively analyzed. Of them, 17 patients were treated with simultaneous bilateral UKAs(simultaneous group) and 14 patients with staged bilateral UKAs(staged group). There was no significant difference in gender, age, body mass index, osteoarthritis grading, and preoperative hip-knee-ankle angle, knee society score(KSS), visual analogue scale(VAS) score, and range of motion(ROM) of knee between the two groups(P>0.05). The operation time, blood loss, hospitalization stay, minimum hemoglobin value during 10 days after operation, and hospitalization cost were recorded. The staged group was compared by the sum of two operations. The effectiveness was evaluated by KSS score, VAS score, ROM at 3, 6, 12 months after operation, and patient satisfaction scores were recorded at 12 months after operation. Results The operation time, hospitalization stay, and hospitalization cost of the simultaneous group were significantly lower than those of the staged group(P<0.05). There was no significant difference in blood loss and the minimum hemoglobin value during 10 days after operation between the two groups(P>0.05).Superficial infection occurred in 1 side of 1 case(7.1%) in staged group. Postoperative delirium occurred in 1 case(5.9%)in simultaneous group. There was no significant difference in incidence of postoperative complications between the two groups(P=1.000). Patients in both groups were followed up 12-32 months(mean, 24.7 months). There was no significant difference in KSS score between the two groups at 3 months after operation(t=0.896, P=0.392). KSS scores were significanly higher in simultaneous group than in staged group at 6 and 12 months after opera

关 键 词：人工单髁关节置换 膝关节 骨关节炎 同期手术 分期手术 早期疗效 安全性 

分 类 号：R687.4[医药卫生—骨科学]