老年骨关节炎单髁与全膝置换的比较  

Unicompartmental knee arthroplasty versus total knee arthroplasty for medical compartment knee osteoarthritis in elderly

作　　者：孟柏屹 李成宇 张骏 MENG Bai-yi;LI Cheng-yu;ZHANG Jun(Department of Orthopedics,Affiliated Hospital,Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院骨科,江苏徐州221000

出　　处：《中国矫形外科杂志》2024年第17期1551-1557,共7页Orthopedic Journal of China

摘　　要：[目的]比较微创单髁置换术(unicompartmental knee arthroplasty,UKA)与全膝置换术(total knee arthroplasty,TKA)治疗老年内侧室骨关节炎(medial compartment knee osteoarthritis,MC-KOA)的临床效果。[方法]回顾性分析2021年9月—2022年9月收治的109例老年MC-KOA患者的临床资料。根据医患沟通结果,59例行UKA术,另50例行TKA术。比较两组围手术期、随访及影像资料。[结果]UKA组手术时间[(61.8±4.7)min vs(80.4±6.5)min,P<0.001]、切口长度[(5.7±0.3)cm vs(6.9±0.4)cm,P<0.001]、术中失血量[(94.3±13.1)ml vs(147.5±19.8)ml,P<0.001]、术后引流量[(169.8±10.0)ml vs(366.7±41.1)ml,P<0.001]、膝关节自主屈曲至90°时间[(13.8±2.2)d vs(17.1±2.4)d,P<0.001]及住院时间[(9.8±1.8)d vs(14.4±2.4)d,P<0.001]均显著少于TKA组。随时间推移,两组VAS评分、KSS评分、膝伸-屈ROM、步速、步频及步幅均显著改善(P<0.05);末次随访时,UKA组KSS评分[(88.2±3.6)vs(82.7±3.1),P<0.001]、膝伸-屈ROM[(123.9±5.7)°vs(116.4±5.1)°,P<0.001]、步速[(98.4±5.3)cm/s vs(85.1±5.9)cm/s,P<0.001]、步幅[(89.3±10.1)cm vs(80.1±11.2)cm,P<0.001]显著优于TKA组。影像方面,随时间推移,两组末次随访时股胫角、髋-膝-踝角、胫骨近端内侧角、胫骨平台后倾角均显著改善(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]老年MC-KOA施行微创UKA术与TKA术均可获得满意的临床疗效,但UKA术在减少手术创伤、促进膝关节功能恢复及改善步态方面更具优势。[Objective]To compare clinical outcomes of unicompartmental knee arthroplasty(UKA)versus total knee arthroplasty(TKA)for medial compartment knee osteoarthritis(MC-KOA)in the elderly.[Methods]A retrospective analysis was conducted on 109 elderly patients who received knee arthroplasty for MC-KOA from September 2021 to September 2022.According to the preoperative doctorpatient communication,59 patients underwent UKA,while other 50 patients underwent TKA.The perioperative,follow-up and imaging data of the two groups were compared.[Results]The UKA group proved significantly superior to the TKA group in terms of operation time[(61.8±4.7)min vs(80.4±6.5)min,P<0.001],length of incision,[(5.7±0.3)cm vs(6.9±0.4)cm,P<0.001],intraoperative blood loss[(94.3±13.1)ml vs(147.5±19.8)ml,P<0.001],postoperative drainage volume[(169.8±10.0)ml vs(366.7±41.1)ml,P<0.001],time to regain active knee flexion of 90°[(13.8±2.2)days vs(17.1±2.4)days,P<0.001],and hospital stay[(9.8±1.8)days vs(14.4±2.4)days,P<0.001].As time went on,the VAS and KSS scores,knee extension-flexion ROM,stride speed,stride frequency and stride length were significantly improved in both groups(P<0.05).At the last follow-up,the UKA group was also significantly better than the TKA in terms of KSS score[(88.2±3.6)vs(82.7±3.1),P<0.001],knee extension-flexion ROM[(123.9±5.7)°vs(116.4±5.1)°,P<0.001],stride speed[(98.4±5.3)cm/s vs(85.1±5.9)cm/s,P<0.001],stride length[(89.3±10.1)cm vs(80.1±11.2)cm,P<0.001].As for imaging,femorotibial angle(FTA),hip-knee-ankle angle(HKA),medial proximal tibial angle(MPTA)and posterior tibial slope(PTS)were significantly improved in both groups at the last follow-up compared with those preoperatively(P<0.05).However,there were no significant differences in the above image indexes between the two groups at any corresponding time points(P>0.05).[Conclusion]Both UKA and TKA do achieve satisfactory clinical consequences for MC-KOA in elderly.In comparison,the UKA has more advantages in reducing surgical trauma,promoting fun

关 键 词：老年人 膝内侧室骨性关节炎 单髁置换术 全膝置换术 

分 类 号：R684.3[医药卫生—骨科学]