膝自发性骨坏死单髁置换与胫骨高位截骨比较  

Unicompartmental knee arthroplasty versus high tibial osteotomy for knee spontaneous osteonecrosis

作　　者：陈金雄[1,2] 周观明[2] 陈希聪[2] 肖可明[2] 郑雅伟[2] 余海波 刘少华[2] CHENJin-xiong;IOU Guan-ming;CHEN Xi-cong;XIAO Ke-ming;ZHENG Ya-wei;YU Hai-bo;LIU Shao-hua(Guangzhou University of Chinese Medicine,Guangzhou 510006,China;Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,China)

机构地区：[1]广州中医药大学,广东广州510006 [2]佛山市中医院,广东佛山528000

出　　处：《中国矫形外科杂志》2023年第23期2142-2147,共6页Orthopedic Journal of China

摘　　要：[目的]比较单髁置换(unicompartmental knee arthroplasty,UKA)与胫骨高位截骨(high tibial osteotomy,HTO)治疗膝关节自发性骨坏死(spontaneous osteonecrosis of the knee,SONK)的临床疗效。[方法]回顾性分析2015年1月—2021年10月治疗的39例SONK患者的临床资料,根据术前医患沟通结果,22例行UKA治疗,17例行HTO治疗。比较两组围手术期、随访和影像资料。[结果]UKA组手术时间[(53.0±6.3)min vs(60.5±8.0)min,P<0.05]、术后下地时间[(3.5±0.9)d vs(5.7±0.7)d,P<0.05]均显著优于HTO组,但前者的切口总长度显著大于后者[(9.2±1.1)cm vs(6.7±0.9)cm,P<0.05],两组术中失血量、切口愈合及住院时间的差异无统计学意义(P>0.05)。随访时间平均(24.7±10.0)个月,UKA组恢复完全负重活动时间显著早于HTO组[(7.1±2.0)d vs(34.5±3.6)d,P<0.05]。随时间推移,两组VAS评分、WOMAC评分、KSS评分均显著改善(P<0.05),膝ROM无显著变化(P>0.05)。术前两组上述指标的差异均无统计学意义(P>0.05),术后不同时间点UKA组的VAS评分、WOMAC评分、KSS评分均显著优于HTO组(P<0.05),但膝ROM比较差异无统计学意义(P>0.05)。影像方面,UKA组的FTA角术后即刻[(182.0±1.9)°vs(173.8±2.1)°,P<0.05]和末次随访[(182.0±1.7)°vs(173.0±2.0)°,P<0.05]均显著优于HTO组;末次随访时UKA组外侧室K-L分级[0/Ⅰ/Ⅱ/Ⅲ/Ⅳ,(17/4/1/0/0)vs(6/7/4/0/0),P<0.05]及髌股室K-L分级[0/Ⅰ/Ⅱ/Ⅲ/Ⅳ,(15/5/2/0/0)vs(4/8/4/1/0),P<0.05]均显著优于HTO组。[结论]UKA与HTO治疗SONK均能取得较好的临床疗效,但UKA组的早期临床疗效优于HTO组。[Objective]To compare the clinical outcomes of unicompartmental knee arthroplasty(UKA)versus high tibial osteotomy(HTO)for spontaneous osteonecrosis of the knee(SONK).[Methods]A retrospective study was conducted on 39 patients who received surgical treatment for SONK treated from January 2015 to October 2021.According to preoperative doctor-patient communication,22 patients received UKA,while the other 17 patients received HTO.The perioperative,follow-up and imaging data were compared between the twogroups.[Results]The UKA group proved significantly superior to the HTO group in terms of operating time[(53.0±6.3)min vs(60.5±8.0)min,P<0.05]and postoperative walking time[(3.5±0.9)days vs(5.7±0.7)days,P<0.05],despite of the fact that the former had significantlylonger total incision length than the latter[(9.2±1.1)cm vs(6.7±0.9)cm,P<0.05].However,there were no significant differences in intraoperative blood loss,incision healing grade and hospital stay between the two groups(P>0.05).All patients in both groups were followed up for(24.7±10.0)months on an average,and the UKA group returned to full weight-bearing activity significantly earlier than HTO group[(7.1±2.0)days vs(34.5±3.6)days,P<0.05].The VAS,WOMAC and KSS scores were significantly improved in both groups over time(P<0.05),whereas the knee range of motion(ROM)was not significantly changed(P>0.05).Although there were no statistically significant differencesin the above indexes between the two groups before surgery(P>0.05),the UKA group was significantly better than the HTO group in terms ofVAS score,WOMAC score and KSS scores at all time points postoperatively accordingly(P<0.05),while without statistically significant differences in knee ROM between the two groups(P>0.05).Radiographically,the UKA group had significantly better femorotibial angle(FTA)than the HTO group immediate postoperatively[(182.0±1.9)°vs(173.8±2.1)°,P<0.05]and at the last follow-up[(182.0±1.7)°vs(173.0±2.0)°,P<0.05].In addition,the UKA group proved significantly superior

关 键 词：膝关节自发性骨坏死 单髁置换 胫骨高位截骨 

分 类 号：R687.4[医药卫生—骨科学]