单髁置换术和全膝置换术治疗膝关节骨性关节炎的近期临床疗效对比观察

发布时间：2018-02-21 19:20

本文关键词： 膝关节骨性关节炎单髁置换术全膝置换术临床近期疗效　出处：《南京中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：通过观察单髁置换术(UKA)和全膝置换术(TKA)治疗膝关节骨性关节炎的近期临床疗效对比,来确定单髁的临床疗效,为其临床推广提供实践依据。方法：患者均来自南京中医药大学附属常州市中医院2013年9月～2014年10月骨伤科住院病人。其中UKA11例,TKA12例。其中UKA男1例(1膝),女10例(11膝)。TKA男3例(4膝),女9例(10膝)。观察手术创伤指标(出血量、手术时间、膝关节屈曲90°的时点、膝关节肿胀度),做出比较。最后,手术前后两组患者的VAS评分、膝关节最大屈曲度、KSS. WOMAC评分统计分析来比较其临床疗效,两组患者的随访时间均为6个月。结果：1、创伤指标：①出血量(总引流量)：单髁组的出血量(180.0±30.332)ml明显小于全膝组的(406.6±87.108)毫升。②手术时间：单髁由于只是对半个间室进行置换,其所用时间(37.73±6.467)分少于全膝所用时间(67.08±6.895)分。③膝关节屈曲90°时点：单髁组所用时间为(5.45±0.473)天少于全膝的(8.42±2.065)天。④关节肿胀度(膝关节周径)：术后1周、2周单髁组(44.45±1.214、40.00±0.894)厘米都小于全膝组(46.00±1.706、41.92±0.996)厘米,3个月后无统计学意义(P0.05)。2、①UKA组11例和TKA组12例患者都取得了比较满意的临床疗效。术后切口都是I/甲愈合,未出现感染、下肢深静脉血栓、假体松动等并发症。②UKA组和TKA组术前的VAS、膝关节最大屈曲度、KSS和WOMAC评分均无统计学意义(P0.05)。两组患者术前无显著差异。③VAS评分：UKA组的VAS由术前的(7.64±0.92)分降到术后末次随访的(2.09±0.83)分,TKA组的VAS由术前的(7.58±0.90)分降到术后末次随访的(2.67±0.89)分,两组患者疼痛缓解明显,但是末次随访时UKA组优于TKA组(P0.05)。④膝关节最大屈曲度,：末次随访时UKA组(122.73±5.17)度明显优于TKA组(118.25±3.864)度(P＜0.01), ⑤KSS临床、功能评分：末次随访,两组患者术后临床和功能评分都有提高,UKA组分别为(89.72±1.42)、(89.18±1.66)分,TKA组分别为(86.58±1.83)、(84.91±1.62)分(P0.01)。⑥WOMAC评分：末次随访时UKA组(6.18±0.98)分优于TKA组的(7.91±1.08)分(P0.01)。结论：UKA、TKA对于单侧间室骨性关节炎均取得了满意的疗效,UKA由于创伤小、手术时间短、恢复快等优点,只要把握适应症,UKA的术后近期疗效可以优于TKA,值得临床推广。
[Abstract]:Objective: to evaluate the clinical efficacy of single condylar replacement (UKA) and total knee replacement (TKA) in the treatment of knee osteoarthritis. Methods: all the patients were from the department of orthopedics and trauma of Changzhou Hospital of traditional Chinese Medicine affiliated to Nanjing University of traditional Chinese Medicine from September 2013 to October 2014. There were 12 cases of UKA11, of which 1 case was UKA male and 10 cases were female. TKA, male, male, n = 11, TKA, n = 3, n = 4, n = 9, n = 10, we observed the surgical trauma index (bleeding volume, n = 10). The time of operation, the time point of knee joint flexion 90 掳, the degree of swelling of knee joint were compared. Finally, the VAS score, the maximum flexion degree of knee joint and KS. WOMAC score before and after operation were statistically analyzed to compare the clinical efficacy of the two groups. The follow-up time of the two groups was 6 months.Results the blood loss of 1: 1 (total drainage volume: 180.0 卤30.332 ml in the single condyle group was significantly lower than 406.6 卤87.108 ml in the whole knee group) 2 ml operation time: the single condyle was only replaced by the half compartment, and the total volume of blood loss in the single condyle group was significantly lower than that in the knee group (406.6 卤87.108 ml). The time taken was 37.73 卤6.467) less than that of the whole knee (67.08 卤6.895). The time of knee flexion 90 掳in the single condyle group was 5.45 卤0.473 days, which was less than 8.42 卤2.065 days in the whole knee. 4. 4 degree of joint swelling (the circumference of knee joint: 44.45 卤1.214v 40.00 卤0.894cm in the moncondylar group 1 week after operation and 2 weeks after operation). Less than 46.00 卤1.706 卤41.92 卤0.996 cm in the whole knee group, there was no statistical significance after 3 months in 11 patients in the TKA group and 11 patients in the TKA group. No infection, deep venous thrombosis of lower extremity, There was no significant difference in preoperative VASand WOMAC scores between TKA group and TKA group. There was no significant difference between the two groups before operation. 3 the VAS score of VAS score in VAS group decreased from 7.64 卤0.92 before operation to the last follow-up after operation. The VAS of TKA group decreased from 7.58 卤0.90 before operation to 2.67 卤0.89 at the last follow-up. The pain relief of the two groups was obvious, but the UKA group was superior to the TKA group in the maximal flexion degree of knee joint at the last follow-up (P < 0.01), and the UKA group was significantly superior to the TKA group in the degree of 118.25 卤3.864 degree (P < 0.01). The clinical and functional scores of the two groups were improved after operation. The score of UKA group was 89.72 卤1.42OU (89.18 卤1.66) and the score of TKA group was 86.58 卤1.83 (84.91 卤1.62WMAC). The score of UKA group (6.18 卤0.98) was better than that of TKA group (6.18 卤0.98). Conclusion the score of UKA group is better than that of TKA group (P 0.01). Conclusion the score of UKA group is better than that of TKA group (P < 0.01). Conclusion the score of UKA group is better than that of TKA group (P < 0.01). Conclusion the score of UKA group is better than that of TKA group (P < 0.01). Conclusion the score of UKA group is better than that of TKA group. Conclusion the score of UKA group is better than that of TKA group. The satisfactory curative effect of UKA due to small trauma, The operation time is short and the recovery is fast. So long as we grasp the indication, the short-term curative effect of UKA can be better than that of TKA. it is worth popularizing.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R274.9

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