胫骨高位截骨与单髁置换的早期疗效比较

doi:10.3877/cma.j.issn.1674-134X.2023.06.019

目的

对比内侧开放楔形胫骨高位截骨术(OWHTO)与内侧单髁置换术(UKA)治疗膝关节内侧单间室骨关节炎合并胫骨近端畸形的疗效。

方法

回顾分析遂宁市中心医院2016年1月至2020年1月收治的膝骨关节炎患者临床疗效。按患者手术类型分为单髁置换组、胫骨高位截骨组，收集分析手术前后的OKS评分和Lysholm功能评分、失血量、手术时间及住院时间等。符合正态分布的计量资料组间比较采用t检验或重复测量方差分析；计数资料以构成比表示，采用卡方检验。

结果

共41例患者，UKA组21例，OWHTO组20例，所有患者至少随访1年。围术期：UKA组显性失血量更少(t＝13.849，P<0.05)，OWHTO手术时间更短(t＝2.263，P<0.05)；术后住院时间差异无统计学意义(P>0.05)。术后3、6个月和1年Lysholm功能评分、OKS评分较术前均有改善。在术后3、6个月时，UKA组Lysholm功能评分、OKS评分优于OWHTO组(t＝－4.471、－2.117、10.076、2.689，均为P<0.05)。术后1年时，两组Lysholm膝关节功能评分、OKS评分组间比较差异无统计学意义(均为P>0.05)。术后两组患者胫股角同术前比较均减小(t＝13.937、22.331，均为P<0.05)，OWHTO组胫股角纠正情况优于UKA组(t＝6.952，P<0.05)。随访期间UKA组1例患者在术后1年发生聚乙烯衬垫脱位，1例患者术后出现手术切口周围及小腿前内侧麻木。OWHTO组未观察到相关并发症发生。

结论

对于膝关节内侧间室骨关节炎合并胫骨近端畸形的患者，UKA与OWHTO术后早期均能取得较好疗效，UKA术后功能改善更迅速，OWHTO能更好地纠正膝内翻。

关键词: 关节成形术，置换，膝, 胫骨, 截骨术, 骨关节炎，膝, 治疗学

Objective

To compare the efficacy of medial open wedge high tibial osteotomy (OWHTO) and medial unicompartmental knee arthroplasty (UKA) in the treatment of medial unicompartmental osteoarthritis of the knee combined with proximal tibial deformity.

Methods

The clinical efficacy of patients with knee osteoarthritis admitted to Suining Central Hospital from January 2016 to January 2020 was retrospectively analyzed. The patients were divided into unicompartmental knee arthroplasty group and high tibial osteotomy group according to the type of surgery. Oxford knee score (OKS), Lysholm function score, blood loss, operation time and hospital stay length were collected and analysed. The measurement data in accordance with normal distribution were compared between groups by t test or repeated measures analysis of variance; the enumeration data were expressed as constituent ratio and chi-square test was used.

Results

There were 41 patients, 21 in the UKA group and 20 in the OWHTO group, and all the patients were followed for at least one year. Before operation, in UKA group, blood loss in less(t=13.849, P<0.05)and shorter OWHTO operation time (t=2.263, P <0.05); no statistically significant difference was found in postoperative hospital stay (P >0.05). Lysholm function score and OKS score at three, six months and one year after operation were improved compared with those before operation. At three and six months after surgery, the Lysholm function score and OKS score in the UKA group were better than those in the OWHTO group (t=-4.471, -2.117, 10.076, 2.689, all P<0.05). One year after surgery, there was no significant difference in Lysholm knee function score and OKS score between the two groups (all P>0.05). The tibiofemoral angle in both groups decreased after operation compared with that before operation (t=13.937, 22.331, both P<0.05), and the correction of tibiofemoral angle in OWHTO group was better than that in UKA group (t=6.952, P <0.05). During the follow-up, one patient in the UKA group developed polyethylene liner dislocation one year after surgery, and one patient developed numbness around the surgical incision and anteromedial leg after surgery. No relevant complication was observed in the OWHTO group.

Conclusions

Both UKA and OWHTO are effective in the early postoperative period in patients with medial compartment osteoarthritis of the knee combined with proximal tibial deformity, and the function of UKA is improved more rapidly. OWHTO can correct genu varus better.

Key words: Arthroplasty, replacement, knee, Tibia, Osteotomy, Osteoarthritis, knee, Treatment outcome

表1 一般资料

Table 1 General information

组别Groups	例数Case number	性别(男/女)Gender(male/female)	年龄[岁，(±s)]Age(year)	BMI[kg/m²，(±s)]	手术侧(左/右)Surgical side(left/right)	K-L分级(Ⅲ/Ⅳ)
UKA组	21	9/12	60±5	25±4	8/13	12/9
OWHTO组	20	7/13	59±4	24±4	8/12	13/7
统计值Statistical value		χ²＝0.266	t＝0.449	t＝0.381	χ²＝0.016	χ²＝0.266
P值		>0.05	>0.05	>0.05	>0.05	>0.05

表1 一般资料

Table 1 General information

组别Groups	例数Case number	性别(男/女)Gender(male/female)	年龄[岁，(±s)]Age(year)	BMI[kg/m²，(±s)]	手术侧(左/右)Surgical side(left/right)	K-L分级(Ⅲ/Ⅳ)
UKA组	21	9/12	60±5	25±4	8/13	12/9
OWHTO组	20	7/13	59±4	24±4	8/12	13/7
统计值Statistical value		χ²＝0.266	t＝0.449	t＝0.381	χ²＝0.016	χ²＝0.266
P值		>0.05	>0.05	>0.05	>0.05	>0.05

表2 两组患者术中出血量、手术时间、术后住院时间(±s)

Table 2 Intraoperative blood loss, operation time and postoperative hospital stay of two groups

组别Groups	例数Case number	术中出血量(ml)Intraoperative blood loss	手术时间(min)Operation duration	住院时间(d)Hospitalization time
UKA组	21	246.2±24.4	80.6±7.5	6.8±1.6
OWHTO组	20	356.7±30.3	75.4±7.2	7.4±1.8
t值		13.849	2.263	1.129
P值		<0.001	0.030	>0.05

表2 两组患者术中出血量、手术时间、术后住院时间(±s)

Table 2 Intraoperative blood loss, operation time and postoperative hospital stay of two groups

组别Groups	例数Case number	术中出血量(ml)Intraoperative blood loss	手术时间(min)Operation duration	住院时间(d)Hospitalization time
UKA组	21	246.2±24.4	80.6±7.5	6.8±1.6
OWHTO组	20	356.7±30.3	75.4±7.2	7.4±1.8
t值		13.849	2.263	1.129
P值		<0.001	0.030	>0.05

表3 两组Lysholm评分比较(±s)

Table 3 Comparison of Lysholm scores between the two groups

组别Groups	例数Case number	术前Before operation	术后3个月Three months after operation	术后6个月Six months after operation	术后12个月Twelve months after operation	F值	P值
UKA组	20	62.1±8.9	71.7±7.1^a	85.3±5.4^ab	90.5±2.7^abc	组别效应10.345	0.003
OWHTO组	21	61.8±8.6	80.6±5.7^a	88.5±4.1^ab	91.2±2.1^abc	测试次数效应188.074	<0.001
t值		0.124	－4.417	－2.117	－0.859	交互效应4.805	0.009
P值		>0.05	<0.001	0.041	>0.05

表3 两组Lysholm评分比较(±s)

Table 3 Comparison of Lysholm scores between the two groups

组别Groups	例数Case number	术前Before operation	术后3个月Three months after operation	术后6个月Six months after operation	术后12个月Twelve months after operation	F值	P值
UKA组	20	62.1±8.9	71.7±7.1^a	85.3±5.4^ab	90.5±2.7^abc	组别效应10.345	0.003
OWHTO组	21	61.8±8.6	80.6±5.7^a	88.5±4.1^ab	91.2±2.1^abc	测试次数效应188.074	<0.001
t值		0.124	－4.417	－2.117	－0.859	交互效应4.805	0.009
P值		>0.05	<0.001	0.041	>0.05

表4 两组OKS评分比较(±s)

Table 4 Comparison of OKS scores between the two groups

组别Groups	例数Case number	术前Before operation	术后3个月Three months after operation	术后6个月Six months after operation	术后12个月Twelve months after operation	F值	P值
UKA组	20	44.1±4.8	36.3±3.3^a	25.1±3.1^ab	20.3±1.9^abc	组别主效应44.866
OWHTO组	21	45.2±4.6	26.2±3.1^a	22.6±2.9^ab	19.2±1.7^abc	测试次数主效应415.990	均为<0.001
t值		－0.748	10.076	2.698	1.861	交互效应20.637
P值		>0.05	<0.001	0.010	>0.05

表4 两组OKS评分比较(±s)

Table 4 Comparison of OKS scores between the two groups

组别Groups	例数Case number	术前Before operation	术后3个月Three months after operation	术后6个月Six months after operation	术后12个月Twelve months after operation	F值	P值
UKA组	20	44.1±4.8	36.3±3.3^a	25.1±3.1^ab	20.3±1.9^abc	组别主效应44.866
OWHTO组	21	45.2±4.6	26.2±3.1^a	22.6±2.9^ab	19.2±1.7^abc	测试次数主效应415.990	均为<0.001
t值		－0.748	10.076	2.698	1.861	交互效应20.637
P值		>0.05	<0.001	0.010	>0.05

图1 UKA(单髁置换)组与OWHTO(开放式楔形胫骨高位截骨)组OKS评分(牛津膝关节评分)

Figure 1 OKS score in UKA and OWHTO groups

图2 UKA(单髁置换)组与OWHTO(开放式楔形胫骨高位截骨)组Lysholm功能评分

Figure 2 Lysholm function score in UKA and OWHTO groups

表5 术前与末次随访胫股角(±s)

Table 5 Tibiofemoral angle at before operation and last follow-up

组别Groups	例数Case number	术前Before operation	术后After operation	t值	P值
UKA组	20	183.5±1.6	176.4±1.7	13.937	<0.001
OWHTO组	21	184.3±1.5	172.6±1.8	22.331	<0.001
t值		1.649	6.952
P值		0.107	<0.001

表5 术前与末次随访胫股角(±s)

Table 5 Tibiofemoral angle at before operation and last follow-up

组别Groups	例数Case number	术前Before operation	术后After operation	t值	P值
UKA组	20	183.5±1.6	176.4±1.7	13.937	<0.001
OWHTO组	21	184.3±1.5	172.6±1.8	22.331	<0.001
t值		1.649	6.952
P值		0.107	<0.001

图3 KOA(膝骨关节炎)病例行右膝UKA(单髁置换)手术前后X线片。图A为术前右膝关节正侧位片，示膝内侧间室骨关节炎；图B术后右膝关节正侧位片，示单髁假体位置良好；图C为术前下肢全长正位片，示右膝内翻，力线异常；图D为术后下肢下肢全长正位片，示右膝力线获得部分矫正

Figure 3 X ray images of right knee with osteoarthritis before and after UKA. A is anteroposterior and lateral views of right knee before surgery, showing osteoarthritis of medial compartment; B is anteroposterior and lateral views of right knee after surgery, showing prosthesis in good position; C is full length image of lower limbs before surgery, showing varus genum of right knee and abnormal alignment; D is full length image of lower limbs after surgery, showing varus genum of right knee had been corrected partly

图4 KOA(膝骨关节炎)病例行左膝OWHTO(开放式楔形胫骨高位截骨)治疗前后X线片。图A为术前左膝关节正侧位片，示膝内侧间室骨关节炎；图B为术后膝关节正侧位片，示截骨后钢板位置良好；图C为术前下肢全长正位片，示左膝内翻，力线异常；图D为术后下肢下肢全长正位片，示左膝力线获得矫正

Figure 4 X ray images of left knee with osteoarthritis before and after UKA. A is anteroposterior and lateral views of left knee before surgery, showing osteoarthritis of medial compartment; B is anteroposterior and lateral views of left knee after surgery, showing prosthesis in good position; C is full length image of lower limbs before surgery, showing varus genum of left knee and abnormal alignment; D is full length image of lower limbs after surgery, showing varus genum of left knee had been corrected

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Early efficacy comparison of open wedge high tibial osteotomy and unicompartmental knee arthroplasty

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Early efficacy comparison of open wedge high tibial osteotomy and unicompartmental knee arthroplasty