[1]郭马珑,崔宏勋,李峰,等.单髁置换术治疗中重度膝关节单间室骨关节炎[J].中医正骨,2017,29(06):16-19,27.
　GUO Malong,CUI Hongxun,LI Feng,et al.Unicondylar knee arthroplasty for treatment of moderate-to-severe unicompartmental knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(06):16-19,27.
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单髁置换术治疗中重度膝关节单间室骨关节炎()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年06期
页码:
16-19,27
栏目:
临床研究
出版日期:
2017-06-20

文章信息/Info

Title:
Unicondylar knee arthroplasty for treatment of moderate-to-severe unicompartmental knee osteoarthritis
作者:
郭马珑; 崔宏勋; 李峰; 郭珈宜; 姚俊娜; 米豫飞; 郭艳幸
河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002
Author(s):
GUO Malong; CUI Hongxun; LI Feng; GUO Jiayi; YAO Junna; MI Yufei; GUO Yanxing
Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
关键词:
骨关节炎; 膝;  关节成形术; 置换; 膝;  截骨术;  胫骨
Keywords:
Key words osteoarthritis; knee;  arthroplasty; replacement; knee;  osteotomy;  tibia
摘要:
目的:探讨单髁置换术治疗中重度膝关节单间室骨关节炎的临床疗效。方法:2013年10月至2015年5月,共纳入中重度膝关节单间室骨关节炎患者60例,Kellgren-Lawrence分级Ⅲ级25例、Ⅳ级35例; 随机分为2组,每组30例,分别采用单髁置换术和胫骨高位截骨术治疗。记录2组患者手术时间、术中出血量、术后下床时间及住院时间。分别于术前和术后12个月,采用疼痛视觉模拟量表(visual analogue scale,VAS)评分和Lysholm膝关节评分评价患者膝关节疼痛和功能情况。结果:2组患者均顺利完成手术。与胫骨高位截骨组相比,单髁置换组手术时间和住院时间较短、术中出血量少、术后下床早[(102.15±12.73)min,(125.79±16.26)min,t=29.762,P=0.046;(9.08±2.03)d,(24.02±3.82)d,t=37.285,P=0.031;(263.19±31.25)mL,(307.58±41.62)mL,t=49.193,P=0.026;(9.02±1.26)d,(67.56±9.64)d,t=76.183,P=0.021]。术前2组患者膝关节疼痛VAS评分及膝关节Lysholm评分组间比较,差异均无统计学意义[(8.54±0.86)分,(8.57±0.89)分,t=0.640,P=1.059;(58.42±5.39)分,(58.46±5.30)分,t=0.609,P=1.068]; 术后12个月,2组患者膝关节疼痛VAS评分均较术前降低[(1.56±0.35)分,(8.54±0.86)分,t=1.021,P=0.000;(3.07±0.61)分,(8.57±0.89)分,t=1.236,P=0.000],膝关节Lysholm评分均较术前增加[(90.28±5.05)分,(58.42±5.39)分,t=5.174,P=0.000;(83.97±6.19)分,(58.46±5.30)分,t=4.927,P=0.000],但2组患者膝关节疼痛VAS评分和膝关节Lysholm评分的组间差异均无统计学意义[(1.56±0.35)分,(3.07±0.61)分,t=2.045,P=0.189;(90.28±5.05)分,(83.97±6.19)分,t=7.617,P=0.165]。结论:与胫骨高位截骨术相比,单髁置换术治疗中重度膝关节单间室骨关节炎,手术时间和住院时间短、术中出血少、下床活动时间早。2种方法均有利于膝关节疼痛的缓解和膝关节功能的恢复,且疗效相当。
Abstract:
ABSTRACT Objective:To explore the clinical curative effects of unicondylar knee arthroplasty(UKA)in the treatment of moderate-to-severe unicompartmental knee osteoarthritis(KOA).Methods:Sixty patients with moderate-to-severe unicompartmental KOA were included from October 2013 to May 2015 and were randomly divided into 2 groups,30 cases in each group.The patients were treated with UKA and osteotomy of proximal tibia(OPT)respectively.According to Kellgren-Lawrence classification,the KOA belonged to gradeⅢ(25)andⅣ(35).The operative time,intraoperative blood loss,bed rest time and hospital stay were recorded and compared between the 2 groups.The knee pain and function were evaluated by using visual analogue scale(VAS)score and Lysholm knee score respectively before the surgery and at 12 months after the surgery.Results:The surgery were finished successfully in all patients.The operative time and hospital stay were shorter and the intraoperative blood loss was less and the bed rest time was shorter in UKA group compared to OPT group(102.15+/-12.73 vs 125.79+/-16.26 min,t=29.762,P=0.046; 9.08+/-2.03 vs 24.02+/-3.82 days,t=37.285,P=0.031; 263.19+/-31.25 vs 307.58+/-41.62 ml,t=49.193,P=0.026; 9.02+/-1.26 vs 67.56+/-9.64 days,t=76.183,P=0.021).There was no statistical difference in knee pain VAS scores and Lysholm knee scores between the 2 groups before treatment(8.54+/-0.86 vs 8.57+/-0.89 points,t=0.640,P=1.059; 58.42+/-5.39 vs 58.46+/-5.30 points,t=0.609,P=1.068).The knee pain VAS scores decreased in both of the 2 groups at 12 months after the surgery(1.56+/-0.35 vs 8.54+/-0.86 points,t=1.021,P=0.000; 3.07+/-0.61 vs 8.57+/-0.89 points,t=1.236,P=0.000).The Lysholm knee scores increased in both of the 2 groups at 12 month after the surgery(90.28+/-5.05 vs 58.42+/-5.39 points,t=5.174,P=0.000; 83.97+/-6.19 vs 58.46+/-5.30 points,t=4.927,P=0.000).However,there was no statistical difference in knee pain VAS scores and Lysholm knee scores between the 2 groups at 12 month after the surgery(1.56+/-0.35 vs 3.07+/-0.61 points,t=2.045,P=0.189; 90.28+/-5.05 vs 83.97+/-6.19 points,t=7.617,P=0.165).Conclusion:UKA has the advantages of shorter operative time and hospital stay,less intraoperative blood loss and shorter bed rest time compared to OPT in the treatment of moderate-to-severe unicompartmental KOA.Both of the 2 methods are conducive to knee pain relief and knee function recovery,and they are similar to each other in the total curative effect.

参考文献/References:

[1] 刘德玉.膝骨关节炎的中西医结合防治新模式[J].中医正骨,2016,28(9):1-4.
[2] 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):68-70.
[3] 中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中华骨科杂志,2007,27(10):793-796.
[4] 中国中医药研究促进会骨科专业委员会,中国中西医结合学会骨伤科专业委员会关节工作委员会.膝骨关节炎中医诊疗专家共识(2015年版)[J].中医正骨,2015,27(7):4-5.
[5] 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,2005:123-124.
[6] 刘云鹏,刘沂.骨与关节损伤和疾病的诊断分类及功能评定标准[M].北京:清华大学出版社,2002:230-231.
[7] 凌晶,章军辉,狄正林,等.微创单髁置换术治疗膝关节单间室骨性关节炎[J].中国微创外科杂志,2014,14(3):243-245.
[8] BANERJEE S,KAPADIA BH,ISSA K,et al.Postoperative blood loss prevention in total knee arthroplasty[J].J Knee Surg,2013,26(6):395-400.
[9] 夏润福,李剑锋,闫金玉,等.全膝关节置换修复老年重度膝骨关节炎:疗效及生活质量评估[J].中国组织工程研究,2014,18(40):6438-6443.
[10] 周秉正,白伦浩,李彬.单髁置换治疗老年膝关节单间室骨关节炎疗效分析[J].现代医学,2016,44(5):701-703.
[11] 李付元,冯世庆,周恒星,等.人工全膝关节置换术治疗膝关节骨关节炎的疗效观察[J].山东医药,2014,54(5):71-73.
[12] 白玉明,张海森,刘畅,等.胫骨高位截骨术治疗单纯内侧间室膝骨关节炎术后炎性细胞因子水平变化研究[J].中国修复重建外科杂志,2017,31(4):422-466.
[13] 胡涛,罗志勤,罗丽珊,等.关节镜下单髁置换治疗中重度膝关节单间室骨关节炎的疗效观察[J].安徽医药,2015,19(8):1543-1545.
[14] 崔黎明,李强等.胫骨高位截骨结合关节镜治疗膝内侧骨关节炎[J].医学理论与实践,2015,28(16):2197-2198.
[15] 谢勇.关节镜下单髁置换治疗中重度膝关节单间室骨关节炎的疗效观察[J].中国继续医学教育,2016,8(17):128-129.

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备注/Memo

备注/Memo:
基金项目:河南省中医临床学科领军人才培育计划项目(HNZYLJ201301009); 国家中医药管理局“平乐郭氏正骨流派传承工作室”建设项目(2012-228) 通讯作者:崔宏勋 E-mail:164358491@qq.com
更新日期/Last Update: 2017-06-20