膝自发性骨坏死单髁置换与胫骨高位截骨比较
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佛山市中医院

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Comparison of UKA and HTO in the treatment of spontaneous osteonecrosis of the knee
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Foshan Hospital of Traditional Chinese Medicine

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    摘要:

    [目的]比较单髁置换(unicompartmental knee arthroplasty,UKA)与胫骨高位截骨(high tibial osteotomy,HTO)治疗膝关节自发性骨坏死(Spontaneous osteonecrosis of the knee ,SONK)的临床疗效。[方法]回顾性分析2015年01月~2021年10月治疗的39例SONK病例。据术前医患沟通结果,22例行UKA治疗(UKA组),17例行HTO治疗(HTO组)。比较两组围术期、随访和影像资料。[结果]两组均顺利手术。UKA组手术时间、术后下地时间、完全负重活动时间少于HTO组(P<0.05);HTO组切口总长度少于UKA组(P<0.05);两组术中失血量、切口愈合及住院时间差异无统计学意义(P>0.05)。随访12~48个月,平均(24.69±10.02)个月。随时间推移,两组的VAS评分及WOMAC评分下降、KSS评分增加(P<0.05);术后不同时点UKA组的VAS评分、WOMAC评分、KSS评分均优于HTO组(P<0.05)。两组间及组内不同时点的膝ROM比较差异无统计学意义(P>0.05)。影像方面,术后即刻及末次随访UKA组的FTA大于HTO组(P<0.05);末次随访UKA组外侧室及髌股室退变轻于HTO组(P<0.05);两组间及组内不同时点的Insall指数比较差异无统计学意义(P>0.05)。[结论]UKA与HTO治疗SONK均能取得较好的临床疗效,但UKA组的早期临床疗效优于HTO组。

    Abstract:

    [Objective] To compare the clinical efficacy of unicompartmental knee arthroplasty (UKA) with high tibial osteotomy (HTO) in the treatment of spontaneous osteonecrosis of the knee (SONK).[Methods] Thirty-nine cases of spontaneous osteonecrosis of the knee treated from January 2015 to October 2021 were retrospectively analyzed. According to the results of preoperative doctor-patient communication, 22 were treated with UKA (UKA group) and 17 were treated with HTO (HTO group). Perioperative period, follow-up and imaging data were compared between the two groups. [Results] Both groups were operated successfully. The operation time, post-operation time and total weight-bearing activity time in UKA group were shorter than those in HTO group (P < 0.05). The total length of incision in HTO group was less than that in UKA group (P < 0.05). There was no significant difference in blood loss, wound healing and hospital stay between the two groups (P > 0.05). Follow-up ranged from 12 to 48 months, with an average of (24.69±10.02) months. With the passage of time, the VAS score and WOMAC score decreased and the KSS score increased in the two groups (P < 0.05). The VAS score, WOMAC score and KSS score in UKA group were better than those in HTO group at different time points after operation (P < 0.05). There was no significant difference in knee ROM between the two groups and at different time points within the group (P > 0.05). In terms of imaging, the FTA of UKA group was higher than that of HTO group immediately after operation and at the last follow-up (P < 0.05). The degeneration of lateral ventricle and patellofemoral ventricle in UKA group was lighter than that in HTO group (P < 0.05). There was no significant difference in Insall index between the two groups and at different time points within the group (P > 0.05). [Conclusion] Both UKA and HTO could achieve better clinical efficacy in the treatment of SONK, but the early clinical efficacy of the UKA group was better than that of the HTO group.

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  • 收稿日期:2022-11-02
  • 最后修改日期:2023-02-11
  • 录用日期:2023-05-06
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