[单髁膝关节置换术治疗超高龄患者膝骨关节炎的短期疗效]
[Short-term effectiveness of unicompartmental knee arthroplasty for knee osteoarthritis in super-age patients].
作者信息
Wang Fangxing, Xue Huaming, Ma Tong, Wen Tao, Yang Tao, Xue Long, Tu Yihui
机构信息
Department of Joint Surgery, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200082, P.R.China.
Department of Joint Surgery, Yangpu Hospital Affiliated to Tongji University, Shanghai, 200082,
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Aug 15;33(8):947-952. doi: 10.7507/1002-1892.201811061.
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 ( =17.33, =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 ( >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 ( =1.05, =0.29). Hemoglobin and HCT of the two groups on the first day after operation were significantly lower than those before operation ( <0.05). There was no significant difference in the postoperative changes of hemoglobin and HCT between the two groups ( >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 follow-up in the two groups ( <0.05). There was significant difference in HSS score between the two groups ( <0.05), and no significant difference was found in ROM, VAS score, and FTA between the two groups ( >0.05). X-ray film showed no adverse position of the prosthesis, infection around the prosthesis, prosthesis loosening, or pathological bright lines.
CONCLUSION
UKA combined with reasonable perioperative management in the treatment of super-age patients over 85 years with knee osteoarthritis is safe and feasible, and can obtain satisfactory short-term effectiveness.
目的
探讨单髁膝关节置换术（UKA）治疗85岁以上超高龄患者膝关节骨关节炎的短期疗效。
方法
选取2013年11月至2017年5月期间接受UKA且符合纳入标准的单侧膝关节单间室骨关节炎老年患者作为研究对象。其中，年龄大于85岁的患者40例（50膝）为超高龄组，年龄52 - 81岁的患者44例（50膝）为对照组。两组患者年龄差异有统计学意义（ =17.33， =0.00）。两组患者的体重指数、内外侧间室退变分级、膝关节内翻畸形、病程、合并疾病以及术前血红蛋白、血细胞比容（HCT）、美国特种外科医院（HSS）评分、膝关节活动度（ROM）、视觉模拟评分法（VAS）评分和股胫角（FTA）比较，差异均无统计学意义（ >0.05）。记录两组患者术前及术后第1天的住院时间、血红蛋白和HCT，并计算术后血红蛋白和HCT的变化。随访期间，测量膝关节ROM、HSS评分和VAS评分；通过X线片观察假体位置和FTA。
结果
两组患者住院时间差异无统计学意义（ =1.05， =0.29）。两组患者术后第1天的血红蛋白和HCT均显著低于术前（ <0.05）。两组患者术后血红蛋白和HCT的变化差异无统计学意义（ >0.05）。超高龄组除4例（5膝）失访外，其余患者均获完整随访。超高龄组随访时间为14至44个月（平均29个月），对照组随访时间为21至33个月（平均24个月）。两组患者术前与末次随访时的HSS评分、VAS评分、膝关节ROM和FTA比较，差异均有统计学意义（ <0.05）。两组患者HSS评分差异有统计学意义（ <0.05），膝关节ROM、VAS评分和FTA差异无统计学意义（ >0.05）。X线片显示假体位置良好，无假体周围感染、假体松动或病理性透亮线。
结论
UKA联合合理的围手术期管理治疗85岁以上超高龄膝关节骨关节炎患者安全可行，可获得满意的短期疗效。
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