单髁置换术治疗老年单间室膝关节骨关节炎的中期疗效

Mid-term clinical outcomes of unicompartmental knee arthroplasty for isolated compartmental osteoarthritis in the elderly

摘要:

目的 评价单髁置换(UKA)术治疗老年单间室膝关节骨关节炎(OA)的中期临床疗效。方法 回顾性分析2007年1月至2009年1月空军总医院骨科收治的单间室膝关节OA患者23例(24膝),其中男性4例,女性19例,年龄52～71岁,平均年龄61.3岁,体质量55～69 kg,平均62.4 kg。由同一医师行UKA术,通过比较患者术前和术后末次随访时膝关节屈曲活动度(ROM)、膝关节学会评分(KSS)及西大略和麦克马斯特大学骨关节指数(WOMAC)进行中期临床疗效评估。采用SPSS 17.0软件对数据进行统计学分析,计量资料用均数±标准差([AKx-D]±s)表示,术前、术后膝关节ROM、KSS、WOMAC比较采用配对t检验,以P＜0.05为差异有统计学意义。结果 所有患者经关节镜探查无UKA术禁忌证,未转行全膝置换(TKA)术,均顺利完成手术。手术时间为(93.8±11.6)min,术中出血量为(196.7±40.1)ml。患者术后无感染、无深静脉血栓发生,手术切口为Ⅰ/甲愈合。患者随访5～7年,平均6.3年,相比手术前,随访末次时的ROM、KSS、WOMAC提高,差异有统计学意义(P＜0.001)。患者随访期间无假体松动、移位及关节翻修等严重并发症。结论 在严格掌握手术适应证的前提下,UKA治疗单间室膝关节OA可获得良好的中期疗效,具有创伤小,恢复快等优点,但长期疗效还有待研究。

Abstract:

Objective To evaluate mid-term efficacy of unicompartmental knee arthroplasty (UKA) for isolated compartmental osteoarthritis in the elderly. Methods A retrospective study was conducted on 23 patients (24 knees) suffered from isolated compart-mental osteoarthritis admitted in our department from January 2007 to January 2009. They were 4 males and 19 females, at mean age of 61.3 years (52-71 years), and weighted 62.4 kg (55-69 kg). All the patients were treated with endo-model sledge UKA by same surgeon. Preoperative and postoperative knee range of motion (ROM), knee society score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were compared to evaluate mid-term clinical outcomes. SPSS 17.0 software was used to analyze the data. The measurement data were expressed as mean±standard deviation ([AKx-D]±s). Preoperative and postoperative knee ROM, KSS and WOMAC were compared by paired t test. P<0.05 was defined as statistical difference. Results All patients had no contraindication for UKA, none of them turned to suffer knee arthroplasty, and all successfully completed surgery. The operation time was (93.8±11.6)min and the blood loss volume was recorded as (196.7±40.1) ml. No infection or deep vein thrombosis occurred in any patient. All surgical incisions healed well. These patients were followed up for 5-7 years (mean 6.3 years). The ROM, KSS and WOMAC were significantly increased when compared with the values preoperatively (P<0.001). During the follow-up, no prosthesis loosening or revision was found in the patients. Conclusion Under strict control of surgical indications, UKA achieves satisfactory mid-term clinical outcome in treatment of isolated compartmental osteoarthritis, with the advantages of minimal incision and quick recovery. But long-term efficacy needs further research.