[1]熊昌军,左云周,严小康,等.膝关节单髁置换术治疗高龄膝关节内侧间室骨关节炎的临床研究[J].中医正骨,2025,37(01):45-50.
　XIONG Changjun,ZUO Yunzhou,YAN Xiaokang,et al.A clinical study of unicompartmental knee arthroplasty for treatment of medial compartment knee osteoarthritis in advanced age patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(01):45-50.
点击复制

膝关节单髁置换术治疗高龄膝关节内侧间室骨关节炎的临床研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期数:
2025年01期
页码:
45-50
栏目:
临床研究
出版日期:
2025-01-20

文章信息/Info

Title:
A clinical study of unicompartmental knee arthroplasty for treatment of medial compartment knee osteoarthritis in advanced age patients
作者:
熊昌军; 左云周; 严小康; 王冠; 付豪; 姜学明
武汉中西医结合骨科医院/武汉体育学院附属医院,湖北 武汉 430079
Author(s):
XIONG Changjun; ZUO Yunzhou; YAN Xiaokang; WANG Guan; FU Hao; JIANG Xueming
Wuhan Orthopaedic Hospital of Integrated Traditional Chinese and Western Medicine(The Affiliated Hospital of Wuhan Sports University),Wuhan 430079,Hubei,China
关键词:
骨关节炎; 膝;  关节成形术; 置换; 膝;  高龄
Keywords:
osteoarthritis; knee;  arthroplasty; replacement; knee;  advanced age
摘要:
目的:探讨膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)治疗高龄膝关节内侧间室骨关节炎的临床疗效和安全性。方法:回顾性分析2020年1月至2023年7月接受UKA治疗的80例膝关节内侧间室骨关节炎患者的病例资料,其中高龄组40例(年龄>75岁)、对照组40例(年龄55～75岁)。比较2组患者的住院时间、手术时间、术中出血量、术后引流量、并发症发生情况,以及术前和末次随访时膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分、膝关节活动度、胫股角(femoral tibial angle,FTA)。结果:2组患者的住院时间、手术时间、术中出血量、术后引流量的组间差异均无统计学意义。80例患者均获随访,高龄组随访时间(19.75±5.10)个月,对照组随访时间(21.65±5.83)个月。末次随访时,2组患者的膝关节疼痛VAS评分均低于术前[(5.60±0.87)分,(1.33±0.66)分,t=-24.730,P=0.000;(5.63±0.98)分,(1.28±0.60)分,t=-23.942,P=0.000],HSS膝关节评分均高于术前[(51.50±5.75)分,(86.33±3.15)分,t=33.560,P=0.000;(51.98±5.44)分,(89.53±3.63)分,t=36.315,P=0.000],膝关节活动度均大于术前(100.70°±8.33°,117.13°±8.31°,t=8.831,P=0.000; 99.88°±9.45°,116.75°±8.20°,t=8.528,P=0.000),FTA均小于术前(185.05°±3.62°,180.23°±2.45°,t=-6.974,P=0.000; 184.95°±3.90°,180.03°±2.31°,t=-6.865,P=0.000); 2组患者的膝关节疼痛VAS评分、膝关节活动度、FTA的组间差异均无统计学意义(t=-0.341,P=0.734; t=-0.198,P=0.844; t=-0.361,P=0.719); 高龄组患者的HSS膝关节评分小于对照组(t=4.041,P=0.000)。 2组患者术后并发症发生率比较,差异无统计学意义(χ2=1.726,P=0.189)。结论:对于年龄>75岁的高龄膝关节内侧间室骨关节炎患者,采用UKA治疗可以缓解膝关节疼痛、改善膝关节活动度、纠正下肢力线和恢复膝关节功能,且安全性高; 其膝关节功能恢复不如年龄55～75岁的患者理想,但足以满足日常生活需求。
Abstract:
Objective:To explore the clinical outcomes and safety of unicompartmental knee arthroplasty(UKA)for treatment of medial compartment knee osteoarthritis(KOA)in advanced age patients.Methods:The medical records of 80 patients who underwent UKA for medial compartment KOA from January 2020 to July 2023 were retrospectively analyzed.The patients were divided into 2 groups according to the age,the ones aged over 75 years old were assigned into advanced-aged group(40 cases),and the ones ranged in age from 55 to 75 years old into control group(40 cases).The hospital stays,operative time,intraoperative blood loss,postoperative drainage volume,and complications were compared between the 2 groups.Furthermore,the knee pain visual analog scale(VAS)score,Hospital for Special Surgery(HSS)knee score,knee range of motion(ROM),and femoral tibial angle(FTA)measured before the surgery and at the last follow-up were also compared between the 2 groups,respectively.Results:There was no statistical difference in hospital stays,operative time,intraoperative blood loss,and postoperative drainage volume between the 2 groups.All patients in the 2 groups were followed up.The patients in the advanced-aged group were followed up for 19.75±5.10 months,and the ones in control group for 21.65±5.83 months.The knee pain VAS score and FTA decreased,while the HSS knee score and knee ROM increased at the last follow-up compared to pre-surgery in the 2 groups (5.60±0.87 vs 1.33±0.66 points,t=-24.730,P=0.000; 5.63±0.98 vs 1.28±0.60 points,t=-23.942,P=0.000; 185.05±3.62 vs 180.23±2.45 degrees,t=-6.974,P=0.000; 184.95±3.90 vs 180.03±2.31 degrees,t=-6.865,P=0.000; 51.50±5.75 vs 86.33±3.15 points,t=33.560,P=0.000; 51.98±5.44 vs 89.53±3.63 points,t=36.315,P=0.000; 100.70±8.33 vs 117.13±8.31 degrees,t=8.831,P=0.000; 99.88±9.45 vs 116.75±8.20 degrees,t=8.528,P=0.000).Further comparison at the last follow-up revealed that there was no statistical difference in the knee pain VAS score,knee ROM and FTA between the 2 groups(t=-0.341,P=0.734; t=-0.198,P=0.844; t=-0.361,P=0.719); while,the HSS knee score was lower in advanced-aged group compared to control group(t=4.041,P=0.000).In addition,there was no statistical difference in the postsurgical complication incidence between the 2 groups(χ2=1.726,P=0.189).Conclusion:UKA can alleviate the knee pain,improve the knee ROM,correct the lower limb alignment,and restore the knee function in treatment of medial compartment KOA in patients aged over 75 years old,and it exhibits high safety.Although the recovery of knee function in patients aged over 75 years old is not as ideal as that in patients aged 55-75 years old,it is enough for the daily life.

参考文献/References:

[1] 季康,陈刚,徐红伟,等.单髁置换术治疗膝关节内侧间室骨关节炎[J].中医正骨,2019,31(11):44-46.
[2] 郝彦明,高焱,叶晓生,等.膝关节单髁置换术治疗膝关节单间室骨性关节炎[J].中国骨与关节损伤杂志,2024,39(2):188-191.
[3] 马尚,王上增.单室膝骨关节炎单髁与全膝置换术短期效果比较[J].中国矫形外科杂志,2021,29(15):1359-1363.
[4] 姜嵩,李广恒,林博文,等.全膝关节置换与单髁膝关节置换治疗膝内侧骨关节炎疗效的对比观察[J].骨科临床与研究杂志,2023,8(4):246-250.
[5] ATIK O S,HANGODY L R,TURAN S.Total versus unicompartmental knee arthroplasty[J].Jt Dis Relat Surg,2023,34(2):235-236.
[6] RIVIÈRE C,SIVALOGANATHAN S,VILLET L,et al.Kinematic alignment of medial UKA is safe:a systematic review[J].Knee Surg Sports Traumatol Arthrosc,2022,30(3):1082-1094.
[7] YOO J D,HUH M H,SHIN Y S.Risk of revision in UKA versus HTO:a nationwide propensity score-matched study[J].Arch Orthop Trauma Surg,2023,143(6):3457-3469.
[8] JENNINGS J M,KLEEMAN-FORSTHUBER L T,BOLOGNESI M P.Medial unicompartmental arthroplasty of the knee[J].J Am Acad Orthop Surg,2019,27(5):166-176.
[9] CRAWFORD D A,BEREND K R,THIENPONT E.Unicompartmental knee arthroplasty:US and global perspectives[J].Orthop Clin North Am,2020,51(2):147-159.
[10] 中华中医药学会.膝骨关节炎中西医结合诊疗指南(2023年版)[J].中医正骨,2023,35(6):1-10.
[11] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:169-178.
[12] 程宇翔,陈歌,陈建,等.膝骨关节炎单髁置换术后下肢冠状位力线对早期临床效果的影响[J].骨科,2022,13(3):198-203.
[13] RODRIGUEZ-MERCHAN E C,KACHOOEI A R.Is there any difference in the survival of conversion TKA after previous HTO in compare to previous uka?Factors to be consi-dered when offering a surgery[J].Arch Bone Jt Surg,2021,9(4):368-370.
[14] MERCIER N,WIMSEY S,SARAGAGLIA D.Long-term clinical results of the Oxford medial unicompartmental knee arthroplasty[J].Int Orthop,2010,34(8):1137-1143.
[15] 郭万首,张启栋,刘朝晖,等.小切口单髁置换术治疗膝关节内侧间室骨关节炎94膝的中短期疗效研究[J].中国矫形外科杂志,2011,19(17):1412-1415.
[16] 刘爱峰,马信龙,崔中赏,等.膝骨性关节炎单髁与全膝置换的荟萃分析[J].中国矫形外科杂志,2021,29(21):1955-1960.
[17] LEE M,CHEN J,SHI L C,et al.No differences in outcomes scores or survivorship of unicompartmental knee arthroplasty between patients younger or older than 55 years of age at minimum 10-year followup[J].Clin Orthop Relat Res,2019,477(6):1434-1446.
[18] ACKROYD C E,WHITEHOUSE S L,NEWMAN J H,et al.A comparative study of the medial St Georg sled and kinematic total knee arthro plasties.Ten-year survivorship[J].J Bone Joint Surg Br,2002,84(5):667-672.
[19] 李翔,干开丰,潘凌霄.两种置换术治疗老年女性内侧间室膝骨关节炎的疗效比较[J].临床骨科杂志,2024,27(2):195-199.
[20] 鞠晓聪,王冰,王峰,等.高龄膝骨关节炎患者人工单髁关节置换疗效分析[J].中国骨伤,2022,35(7):637-643.
[21] 张启栋,郭万首,刘朝晖,等.单髁与全膝关节置换术治疗高龄患者的配对病例对照研究[J].中华关节外科杂志(电子版),2017,11(1):4-8.
[22] 曹振武,王竣,麦秀钧,等.单髁关节置换治疗高龄内侧膝骨关节炎[J].广东医学,2019,40(9):1216-1220.
[23] 王方兴,薛华明,马童,等.人工单髁关节置换术治疗超高龄膝关节骨关节炎患者的近期疗效[J].中国修复重建外科杂志,2019,33(8):947-952.
[24] 张启栋,郭万首,刘朝晖,等.80岁以上高龄膝关节骨关节炎应用单髁关节置换治疗的临床研究[J].生物骨科材料与临床研究,2015,12(2):21-24.
[25] 明朝戈,明立功,王现海,等.牛津单髁关节置换术治疗超高龄膝关节前内侧骨性关节炎的近期疗效[J].实用手外科杂志,2023,37(2):267-269.
[26] 陈国华,刘声野,李波霞,等.肌间静脉血栓的抗栓治疗[J].介入放射学杂志,2023,32(9):936-941.
[27] ZHANG B,QIAN H,WU H,et al.Unicompartmental knee arthroplasty versus high tibial osteotomy for medial knee osteoarthritis:a systematic review and meta-analysis[J].J Orthop Surg(Hong Kong),2023,31(1):10225536231162829.
[28] W-DAHL A,ROBERTSSON O,LIDGREN L,et al.Unicompartmental knee arthroplasty in patients aged less than 65[J].Acta Orthop,2010,81(1):90-94.

相似文献/References:

[1]樊庆阳,任凯晶.定制3D打印切模辅助全膝关节置换术治疗 膝骨关节炎合并股骨干骨折畸形愈合[J].中医正骨,2015,27(11):37.
[2]刘晓雅,孙永强,刘国杰.主动快速康复锻炼对全膝关节置换术后关节活动度的影响[J].中医正骨,2015,27(09):73.
[3]郑春松,叶蕻芝,李西海,等.透骨消痛胶囊中补肾柔肝药和活血祛风药治疗 骨关节炎作用方式的计算机模拟比较[J].中医正骨,2015,27(07):6.
　ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Comparison of the mode of action of Bushen Rougan(补肾柔肝)drugs versus Huoxue Qufeng(活血祛风)drugs contained in Tougu Xiaotong Jiaonang(透骨消痛胶囊)for the treatment of osteoarthritis:A computer simulation study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):6.
[4]宋兵华,孙俊英,倪增良,等.全膝关节置换术前CT测量股骨后髁角的临床意义[J].中医正骨,2015,27(07):38.
[5]郑春松,叶蕻芝,李西海,等.独活寄生汤含药血清对白细胞介素1β诱导的 退变关节软骨细胞中基质金属蛋白酶 和环氧化酶2表达的影响[J].中医正骨,2015,27(12):1.
　ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Impact of Duhuo Jisheng Tang(独活寄生汤)medicated serum on expression of matrix metalloproteinase and cyclooxygenase 2 in degenerative articular chondrocytes induced by interleukin-1 beta[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):1.
[6]王金良,孙京涛,李玲,等.骨水泥联合螺钉修复全膝关节置换术中 胫骨平台内侧骨缺损[J].中医正骨,2015,27(12):55.
[7]冯荣,王平,李炳奇,等.铍针刺络拔罐结合中药口服治疗膝骨关节炎合并 原发性血小板增多症1例[J].中医正骨,2015,27(12):73.
[8]蔡云仙.围手术期耳穴按压联合平衡针疗法 在全膝关节置换术后镇痛中的应用[J].中医正骨,2015,27(06):41.
[9]张荣,王健.人工全膝关节置换术的围手术期心理护理[J].中医正骨,2015,27(05):77.
[10]喻长纯,杨明路,王战朝.不同手术方式治疗胫骨平台骨折畸形愈合的体会[J].中医正骨,2015,27(03):37.
[11]孟维娜,明立功,王新德,等.关节镜下清理联合腓骨近1/3段截骨治疗膝骨关节炎[J].中医正骨,2015,27(11):40.
[12]明立功,孟维娜,王新德,等.腓骨近端截骨治疗内侧间室膝骨关节炎的近期疗效观察[J].中医正骨,2015,27(10):25.
[13]张杰,王人彦,张玉柱.膝骨关节炎的治疗进展[J].中医正骨,2015,27(10):68.
[14]梁朝,蔡静怡,闫立,等.针刀疗法改善膝骨关节炎早期疼痛症状的疗效评价[J].中医正骨,2015,27(09):9.
　LIANG Zhao,CAI Jingyi,YAN Li,et al.Evaluation of the curative effect of needle-knife therapy for relieving knee pain in patients with early knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):9.
[15]王建武,党建军,李强,等.四联疗法治疗膝骨关节炎[J].中医正骨,2015,27(08):44.
[16]刘红娟,郭会利,郭树农.云克联合中药治疗膝骨关节炎的护理[J].中医正骨,2015,27(08):75.
[17]陈卫衡.探索建立系统的膝骨关节炎中医临床科研范式 和理论体系[J].中医正骨,2015,27(07):1.
[18]帅波,沈霖,杨艳萍,等.加味青娥丸治疗膝骨关节炎的作用机制研究[J].中医正骨,2015,27(07):15.
　SHUAI Bo,SHEN Lin,YANG Yanping,et al.Study on the mechanism of action of Jiawei Qing'e Wan(加味青娥丸)for the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):15.
[19]梅其杰,袁长深,段戡,等.壮药骨痹方烫熨联合运动疗法治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(07):27.
　MEI Qijie,YUAN Changshen,DUAN Kan,et al.Clinical study of the curative effect of hot compressing and rubbing with packet of Gubi Fang(骨痹方)combined with exercise therapy in the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):27.
[20]王丹辉,张燕,刘丽娟,等.重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白 关节腔注射联合中药薰洗治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(07):31.
　WANG Danhui,ZHANG Yan,LIU Lijuan,et al.Clinical study on intra-articular injection of TypeⅡrecombinant human tumor necrosis factor receptor-Fc fusion protein combined with Chinese herbal steaming and washing therapy for treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):31.

备注/Memo

备注/Memo:
通讯作者:左云周 E-mail:zyz672@163.com
更新日期/Last Update: 1900-01-01