摘要
[目的]比较联合关节镜与常规单髁置换治疗膝内侧骨关节炎的临床疗效。[方法] 2013年9月～2017年6月就诊本科准备行单髁置换术的患者83例(94膝),随机分成两组。其中,联合组49膝行关节镜联合单髁置换术,常规组45膝行常规单髁置换术。记录围手术期资料,采用关节活动度(ROM),美国膝关节协会评分(KSS),西大略和麦克马斯特大学骨关节指数(WOMAC),膝关节视觉模拟评分(VAS)评定临床效果。[结果]联合组有1膝镜下外侧间室局部软骨病变为Outerbridge IV级,改行全膝关节置换术,余82例(93膝)行单髁置换术。联合组手术时间显著长于常规组,差异有统计学意义(P<0.05),但两组术中出血量、住院天数的差异无统计学意义(P>0.05),随访时间12～45个月,平均(30.32±10.51)个月,与术前相比较,末次随访时两组ROM、KSS、WOMAC和VAS评分均显著改善(P<0.05)。末次随访时,联合组ROM、WOMAC和VAS优于常规组,差异均有统计学意义(P<0.05),但两组间KSS评分差异无统计学意义(P>0.05)。至末次随访,两组患者均未发生关节感染、假体松动等并发症。[结论]尽管关节镜联合单髁置换增加了手术时间,但能更准确选择手术适应证,并改进临床效果。
[Objective] To compare the clinical outcomes of unicompartmental knee arthroplasty(UKA) combined with and without arthroscopy for knee medial compartment osteoarthritis. [Method] From September 2013 to June 2017, a total of 83 patients(94 knees) who were candidates of UKA for knee medial compartment osteoarthritis in our department were included into this study and divided randomly into two groups. Of them, 49 knees underwent arthroscopy followed by knee arthroplasty(the combined group), while the remaining 45 knees received conventional UKA without arthroscopy(the conventional group). The perioperative data, range of motion(ROM), American Knee Society Score(KSS), Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC), and visual analogue scale(VAS) for pain were compared between the two groups. [Results] Except 1 patient who was changed to total knee arthroplasty due to Outerbridge Grade IV chondral damaged revealed by arthroscopy in the combined group, the remaining 82 patients(93 knees) received UKA. Although the combined group consumed significantly longer operation time than the conventional group(P<0.05), no statistically significant differences in intraoperative blood loss and hospital stay were found between the two groups(P>0.05). The follow-up period lasted for 12～45 months with an average of(30.32±10.51) months. Compared with those before operation, the ROM, KSS WOMAC and VAS scores in both groups significantly improved at the latest follow-up(P<0.05). The combined group proved significantly superior to the conventional group regarding to ROM, WOMAC and VAS scores(P<0.05), nevertheless no a statistically significant difference in KSS score between them at the last interview(P>0.05). To the latest follow-up no serious complications, such as prosthetic infection or loosening, happened in any patients of the two groups.[Conclusion] Despite of total operation time prolonged, the arthroscopy prior to UKA does facilitate to select a more suitable surgical procedure personally, and improve the clinical consequence.
引文
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