同一患者同期行全膝和单髁置换术的早期临床疗效-中华老年骨科与康复电子杂志

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Title:: Clinical Analysis of the Early Effect of Synchronous Total and Unicompartmental Knee Arthroplasty in the Same Patient

作者:: 周晓强; 孙超; 虞宵; 金宇杰; 李志强; 张向鑫; 陈广祥; 215000 苏州，南京医科大学姑苏学院，南京医科大学附属苏州医院，苏州市立医院关节外科

Author(s):: Zhou Xiaoqiang; Sun Chao; Yu Xiao; Jin Yujie; Li Zhiqiang; Zhang Xiangxin; Chen Guangxiang.; Gusu School, Nanjing Medical University, The Affiliated Suzhou Hospital of Nanjing Medical University, Department of Joint Surgery, Suzhou Municipal Hospital, Suzhou 215000, China

Keywords:: Osteoarthritis; Knee; Arthroplasty; Replacement; Knee; Leg Length Inequality

DOI:: 10.3877/cma.j.issn.2096-0263.2023.05.004

文献标志码:: A

摘要:: 目的探讨同一患者同期行全膝关节置换术和单髁置换术治疗双膝骨关节炎的早期临床疗效。方法回顾性分析从2018年1月1日至2020年12月1日因双膝骨关节炎接受同期行全膝和单髁置换术的患者16例。记录手术时间、止血带时间、住院时间和输血率。比较患者双侧术后髋-膝-踝（HKA）角和下肢长度，计算下肢长度差异（LLD）。统计术后2年时的KSS-f评分、OKS评分、EQ-5D评分和FJS评分，并分别记录两侧的KSS-c评分。结果所有患者均完成随访，平均随访（34.81±6.01）月。患者平均手术时间为（118.63±5.54）分，总止血带时间为（84.88±5.63）分，住院时间为（7.25±1.65）d。无患者需输血治疗。术后TKA侧HKA角和下肢长度与UKA侧接近，差异无统计学意义。TKA侧HKA改变量为（7.25±4.33）°，UKA侧为（4.17±4.20）°，TKA侧改变的HKA角度更大，差异有统计学意义（Z=2.275，P=0.023）。TKA侧下肢长度改变量为（12.66±6.29）mm，UKA侧为（5.30±3.05）mm，TKA侧下肢长度增加的更多，差异有统计学意义（Z=3.103，P=0.002）。术后2年时KSS-f评分为（82.63±4.70）分，OKS评分为（17.31±3.70）分，TKA侧术后KSS-c评分为（78.94±7.41）分，UKA侧为（83.88±5.77）分，均较术前增高，差异有统计学意义（P＜0.001）。FJS评分为（69.81±4.64）分，EO-5D评分为（73.88±8.21）分。所有患者均未出现肺栓塞和有症状的深静脉血栓，无膝关节僵硬，关节感染和保留间室骨关节炎进展等并发症。结论同期行一侧TKA，对侧UKA是治疗双膝骨关节炎的有效方法，能取得令人满意的临床疗效，且不会导致术后双下肢长度差异。

Abstract:: Objective To explore the early clinical effect of synchronous total and unicompartmental knee arthroplasty in the treatment of bilateral knee osteoarthritis in the same patient. Methods From January 2018 to December 2020, 16 patients with bilateral knee osteoarthritis who underwent total and unicompartmental knee arthroplasty at the same time were analyzed retrospectively. The operation time, tourniquet time, hospitalization time and blood transfusion rate were recorded. The hip-knee-ankle (HKA) angle and lower limb length of patients after bilateral surgery were compared, and the leg length discrepancy (LLD) was calculated. Knee society score-function (KSS-f), Oxford knee score (OKS), EuroQol Five Dimensions Questionnaire (EQ-5D) and Forgotten joint score (FJS) at 2 years after operation were counted, and Knee society score-clinic (KSS-c ) on both sides were recorded. Results All patients were followed up for an average of (34.81±6.01) months. The average operation time was (118.63±5.54) minutes, the total tourniquet time was( 84.88±5.63) minutes, and the hospital stay was (7.25±1.65) days. No patient needed blood transfusion. The HKA angle and lower limb length on TKA side were similar to those on UKA side, with no significant difference. The change of HKA on TKA side was (7.25±4.33)°, and that on UKA side was (4.17±4.20)°. The change of HKA angle on TKA side was more significant (Z=2.275, P=0.023). The length variation of lower limb on TKA side was (12.66±6.29)mm, while that on UKA side was (5.30±3.05)mm. The length of lower limb on TKA side increased more, with a statistically significant difference (Z=3.103, P=0.002). Two years after operation, the KSS-f score was (82.63±4.70) points, the OKS score was (17.31±3.70) points, the KSS-c score on the TKA side was (78.94±7.41) points, and the UKA side was (83.88±5.77) points, both of which were significantly higher than those before operation (P<0.001). The FJS score was (69.81±4.64), and the EO-5D score was (73.88±8.21). None of the patients had occurred complications, as pulmonary embolism, symptomatic deep vein thrombosis, knee stiffness, joint infection, and the progression of reserved compartmental osteoarthritis. Conclusions At the same time, one side of TKA and the other side of UKA are effective methods for the treatment of knee osteoarthritis, which can achieve satisfactory clinical effects, and will not lead to differences in the length of lower limbs after surgery.

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

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