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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

Short-term effectiveness of unicompartmental knee arthroplasty for knee osteoarthritis in super-age patients
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摘要 目的探讨人工单髁关节置换术(unicompartmental knee arthroplasty,UKA)治疗85岁以上超高龄膝关节骨关节炎患者的近期疗效。方法以2013年11月-2017年5月接受UKA的单间室膝关节骨关节炎患者为研究对象,其中年龄≥85岁患者40例(50膝)(超高龄组),年龄为52~81岁患者44例(50膝)(对照组)。两组除年龄差异有统计学意义(t=17.33,P=0.00)外,体质量指数、内外侧间室退变分级、膝内翻畸形、病程、合并疾病以及术前血红蛋白、红细胞比容(hematocrit,HCT)、美国特种外科医院(HSS)评分、膝关节活动度、疼痛视觉模拟评分(VAS)以及胫股角等一般资料比较,差异无统计学意义(P>0.05)。记录两组住院时间,术前及术后第1天血红蛋白及HCT,计算其变化值,手术相关并发症发生情况。定期随访测量膝关节活动度,采用HSS评分评价膝关节功能,VAS评分评价关节疼痛程度;X线片复查假体位置,测量胫股角。结果超高龄组住院时间与对照组比较,差异无统计学意义(t=1.05,P=0.29)。超高龄组及对照组术后第1天血红蛋白、HCT均明显低于术前(P<0.05);组间血红蛋白、HCT变化值比较,差异均无统计学意义(P>0.05)。除超高龄组4例(5膝)外,其余患者均获完整随访。超高龄组随访时间14~44个月,平均29个月;对照组随访时间21~33个月,平均24个月。末次随访时,两组膝关节HSS评分、VAS评分、膝关节活动度、胫股角与术前比较,差异均有统计学意义(P<0.05)。两组间HSS评分差异有统计学意义(P<0.05),膝关节活动度、VAS评分、胫股角差异无统计学意义(P>0.05)。X线片复查显示无假体位置不良、假体周围感染、假体松动及病理性透亮线。结论 UKA治疗85岁以上超高龄膝关节骨关节炎患者,经合理围术期管理可获得满意近期疗效。 Objective To investigate the short-term effectiveness of unicompartmental knee arthroplasty(UKA in the treatment of knee osteoarthritis of super-age patients over 85 years old. Methods Senile patients with unilateral compartment osteoarthritis of the knee who received UKA between November 2013 and May 2017 and met the inclusion criteria were enrolled as the research objects. Among them, 40 patients(50 knees) were more than 85 years old(super-age group) and 44 patients(50 knees) were 52-81 years old(control group). There was significant difference in age between the two groups(t=17.33, P=0.00). There was no significant difference in body mass index, degenerative classification of medial and lateral compartments, varus deformity of knee, disease duration, complicating diseases, and preoperative hemoglobin, hematocrit(HCT), American Hospital for Special Surgery(HSS) score, range of motion(ROM) of knee,visual analogue scale(VAS) score, and femoral-tibial angle(FTA) between the two groups(P>0.05). Hospital stay,hemoglobin, and HCT of the two groups were recorded before operation and on the first day after operation. The changes of hemoglobin and HCT after operation were calculated. During follow-up period, the ROM of the knee, HSS score, and VAS score were measured;the position of the prosthesis and FTA were observed by X-ray films. Results There was no significant difference in hospital stay between the two groups(t=1.05, P=0.29). Hemoglobin and HCT of the two groups on the first day after operation were significantly lower than those before operation(P<0.05). There was no significant difference in the postoperative changes of hemoglobin and HCT between the two groups(P>0.05). All the patients were followed up completely except 4 cases(5 knees) in the super-age group. The follow-up time ranged from 14 to 44 months of super-age group(mean, 29 months) and 21 to 33 months of control group(mean, 24 months). There were significant differences in HSS score, VAS score, ROM of the knee, and FTA between pre-operation and last
作者 王方兴 薛华明 马童 文涛 杨涛 薛龙 涂意辉 WANG Fangxing;XUE Huaming;MA Tong;WEN Tao;YANG Tao;XUE Long;TU Yihui(Department of Joint Surgery,Yangpu Hospital Affiliated to Tongji University,Shanghai,200082,P.R.China)
出处 《中国修复重建外科杂志》 CAS CSCD 北大核心 2019年第8期947-952,共6页 Chinese Journal of Reparative and Reconstructive Surgery
基金 上海市卫生和计划生育委员会科研课题(201840187) 上海市科学技术委员会科研计划课题(18411969800).
关键词 人工单髁关节置换术 膝关节 骨关节炎 超高龄患者 Unicompartmental knee arthroplasty knee osteoarthritis super-age patient
作者简介 通信作者:涂意辉,Email:dongying3124@126.com.
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