同期与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对比研究

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摘要目的通过对比研究，探讨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临床疗效。方法回顾性比较自2017年3月至2020年3月接受双侧UKA治疗的52例患者临床资料，分为双膝同期置换A组和分期置换B组。A组共24例，其中男8例，女16例；年龄62~75岁，平均(65.8±7.6)岁；身体质量指数(body mass index，BMI)为24.5~28.6 kg/m²，平均(26.2±1.5)kg/m²；K-L分级Ⅲ级14例，Ⅳ级10例。B组共28例，其中男10例，女18例；年龄63~76岁，平均(66.2±6.8)岁；BMI为24.8~28.2 kg/m²，平均(25.8±1.8)kg/m²。K-L分级Ⅲ级16例，Ⅳ级12例。所有病例手术均由同一组医师完成。分别收集两组患者性别、年龄、体重指数、骨关节炎分级以及术前美国特种外科医院(hospital for special surgery，HSS)膝关节评分、疼痛视觉模拟评分(visual analogue scale，VAS)、膝关节活动度等一般资料，两组比较差异均无统计学意义(P＞0.05)。记录手术时间、住院时间、术后1周内血红蛋白最大下降值及术后总引流量，分期组以两次手术总和进行比较。术后每3个月采用 HSS评分、VAS评分、膝关节活动度评价手术疗效。结果患者均获得随访，随访时间12~24个月，平均(18.6±5.8)个月。术后A组发生1例下肢远端肌间隙静脉血栓，B组出现1例切口浅表感染，均正规治疗后康复出院。两组随访期间均无膝关节脱位、假体感染、假体松动发生。两组术后末次随访HSS评分、VAS评分及膝关节活动度比较差异均无统计学意义(P＞0.05)。同期组手术时间及住院时间均低于分期组(P＜0.05)，两组术后1周内血红蛋白最大下降值及术后总引流量比较差异无统计学意义(P＞0.05)。结论同期与分期人工单髁关节置换治疗双膝前内侧骨关节炎术后效果相当，但双侧同期手术患者累计手术时间及住院时间较短，患者可以从一次住院和麻醉中获益，有效降低患者负担。

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	梅晓亮 1
	丁浩 2
	黄爱兵 1
	朱伟 1
	赵建宁 2*

关键词 ：人工单髁关节置换, 同期手术, 分期手术, 骨关节炎

Abstract：Objective To investigate the early clinical efficacy of simultaneous and staged unicommental knee arthroplasty(UKA) for anterior medial knee osteoarthritis. Methods The clinical data of 52 patients with bilateral anteromedial compartment osteoarthritis who underwent bilateral UKAs between March 2017 and March 2020 was retrospectively analyzed.Of them，24 patients were treated with simultaneous bilateral UKAs (simultaneous group A) and 28 patients with staged bilateral UKAs (staged group B).All surgeries were performed by the same surgeons.General data such as gender，age，body mass index，osteoarthritis grading，American Hospital for Special Surgery Knee Score (HSS)，visual analogue scale (VAS) an drange of motion (ROM) of knee were collected for comparison between the two groups，and the differences before operation were not statistically significant (P＞0.05).Operationtime，length of hospital stay，maximum haemoglobin decline within 1 week after surgery，and postoperative drainage volumewere recorded.The staged group was compared with the sum of the two operations.The effectiveness wasevaluated by HSS score，VAS score and ROM of knee at3 months after surgery.Results All patients were followed up for 12 to 24 months，with an average of (18.6±5.8)months.Postoperative intermuscular vein thrombosis of distal lower extremityoccurred in group A and superficial incision infection in group B were found in 1 case.All patients were discharged from hospital and recovered afterregulartreatment.No knee dislocation，prosthesis infection or prosthesis loosening occurred in the two groups during the follow-up period.There were no statistically significant differences in HSS scores，VAS scores and ROM of knee between the two groups at last follow-up after surgery (P＞0.05).The operation time and hospitalization stay of thesimultaneous group were significantly lower than those of the staged group (P＜0.05)，and there was no significant difference in the maximum decrease of hemoglobin in the first week and total drainage volume after operation between the two groups (P＞0.05). Conclusion Our results demonstrated that simultaneous and staged bilateralunicompartmental knee arthroplasty for the treatment ofbilateral anteromedial compartmentosteoarthritis has the comparable effect.Patients can benefit from a single hospitalization and anaesthesia.However，the total length of the operation time and hospitalization is shorter for patients undergoing bilateral simultaneous surgery，which effectively reduces the burden on patients.

Key words： unicompartmental knee arthroplasty simultaneous operation staged operation osteoarthritis

基金资助:国家自然科学基金(81772318)

通讯作者: 赵建宁

作者简介: 梅晓亮(1984－ )，男，副主任医师，南京医科大学泰州临床医学院，泰州市人民医院骨科，225300。

引用本文:

梅晓亮 1，丁浩 2，黄爱兵 1，朱伟 1，赵建宁 2*. 同期与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对比研究[J]. 实用骨科杂志, 2021, 27(10): 903-912.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I10/903

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