胫骨高位截骨与膝单髁置换治疗内侧 间室骨关节炎的近期疗效比较

Comparison of short-term effectiveness between high tibial osteotomy and unicompartmental knee arthroplasty for medial compartment osteoarthritis

摘要:

目的 选取同时满足高位胫骨截骨（HTO）与膝关节单髁置换手术适应证的内侧间室骨关节炎患 者，比较采用开放楔形胫骨高位截骨术与Oxford Ⅲ单髁置换治疗的近期临床疗效。方法 回顾性分析2016 年 1 月—2017 年1 月于西南医科大学附属医院骨与关节外科收治的膝关节内侧间室骨关节炎患者40 例，根据患 者意愿选择手术方式，其中行胫骨高位截骨结合关节镜治疗患者18 例（HTO 组），患者均采用开放楔形胫骨 高位截骨术；行膝单髁置换结合关节镜治疗患者22 例（膝关节单髁置换组），患者均采用Oxford Ⅲ单髁系 统。比较两组患者术中出血量、手术时间、术后下地时间，VAS、KOOS、IKDC、Lysholm 膝关节评分，胫 股角及膝关节活动范围（ROM）。结果 两组患者末次随访KOOS、IKDC 及Lysholm 膝关节评分均较术前 高（P <0.05），VAS 评分较术前低（P <0.05），两组患者末次随访胫股角较术前低（P <0.05）。结论 对于同时满足HTO 与膝关节单髁置换手术适应证的内侧间室骨关节炎患者，两种手术都是有效方法，近期疗效满意 均无明显差异，但远期疗效有待进一步随访观察。

Abstract:

Objective To assess the short-term clinical outcome of opening wedge valgus-producing osteotomy compared with Oxford Ⅲ unicompartmental knee replacement in medial unicompartmental osteoarthritis (OA) of the knee that is not only suitable for HTO but also for UKA. Methods We designed retrospective study 40 patients with medial unicompartmental osteoarthritis (OA) of the knee in our department between January 2016 and January 2017. Two groups of patients underwent arthroscopy combined with HTO in 18 cases (HTO group) and arthroscopy combined with UKA in 22 cases (UKA group). Closing wedge osteotomy was used in HTO group, and Biomet Oxford Ⅲ unicompartmental knee prosthesis in UKA group. All patients were followed up (18.88±5.18) months on average. The operative time, intraoperative blood loss, bed rest time, visua analog scale (VAS) score, The Knee Injury and Osteoarthritis Outcome Scores (KOOS), International Knee Documentation Committee (IKDC) Score, Lysholm knee score, femorotibialangle (FTA) and knee range of motion (ROM) were compared between two groups. Results KOOS, IKDC and Lysholm knee joint scores were higher in the last follow-up of the two groups than before (P < 0.05), VAS score was lower than before (P < 0.05), and tibiofemoral angle was lower in the last follow-up of the two groups than before (P < 0.05). Conclusions Both HTO and UKA are effective methods for the medial unicompartmental osteoarthritis patients that are not only suitable for HTO but also for UKA. The short-term effectiveness are satisfactory and with no significant difference, but the long-term effectiveness need further follow-up observation.