膝关节单髁置换与全膝置换术后早期对照研究

发布时间：2018-05-10 23:07

本文选题：单髁膝关节置换术 + 假体　；参考：《天津医科大学》2015年硕士论文

【摘要】：单髁膝关节置换术(unicompartmental knee arthroplasty,UKA)是一种治疗膝关节炎的常见的手术方式,通过表面置换病变间室,达到减轻疼痛程度、恢复到接近膝关节正常生理功能的目的。具有手术创伤小,骨量丢失少,疼痛轻的优点,术后恢复快,术后本体感觉接近生理状态,易翻修等优点,是治疗骨性关节炎的常见操作。全膝关节置换术(total knee arthroplasty,TKA)这种手术方法在临床上使用已经非常广泛,经常见于各类文献报道,且技术成熟,被公认为是严重膝关节病变治疗的金标准,手术疗效显著,但缺点是创伤较大,术后病人康复时间较长。近年来,假体设计日趋成熟,同时手术器械不断的翻新,在合理的掌握手术操作技术的情况下,手术疗效的大幅提高使得UKA在膝骨关节炎的治疗中已经取得了相当惊人的进步。把握好手术适应症,手术效果是令人满意的,患者满意度明显提高。同时UKA保存了骨量,基本保持正常的解剖关系,术后并发症少、本体感觉好,具有很好的临床应用前景。我院于2013年开展此手术,目前手术例数仍较少,为12例。通过本文的分析研究,明确这种手术方式在单间室病变的治疗过程中所体现的安全性、创伤量及临床治疗效果等,为今后此类患者的治疗做出指导方向。目的通过对已经完成的12例UKA和选取相同年龄段、病变程度相似的12例TKA进行分析,研究两种手术方式在术后早期的治疗效果,将单间室病变的膝骨关节炎术后的安全性、创伤量及临床疗效进行对比分析,观察此类病变部位局限于单一间室的病人是否行UKA更具有优势。方法将2013年4月至2015年1月间的住院患者24例,分为两组,其中进行UKA的12例患者为UKA组,进行TKA12例的患者为TKA组,UKA组年龄51-87岁,男性患者6例,女性患者6例。TKA组平均年龄53-80岁,男性患者6例,女性患者6例。上述24例患者均为单间室病变的膝骨关节炎患者。本研究单间室病变患者的诊断标准是患处仅局限于内侧间室;小于5°的固定屈曲畸形;膝关节主动活动度至少90°;以及内翻畸形小于15°。两组患者身体情况在正常范围内,血糖和血压均得到了有效控制。且均无过度肥胖,无炎症性关节炎和多关节疾病,无明显静息痛。患者术前膝关节屈曲至少90°,关节活动受限为内翻15°,病变主要局限于膝内侧间室。术后第一天、第三天、第七天、术后一个月、术后三个月进行分析和随访,出院后采用门诊和给患者或家属打电话等随访方式,采集手术操作后的影像学资料,查看患者是否发生切口感染,假体松动,下沉或位于不良位置,聚乙烯衬垫脱位,假体断裂、骨折,下肢深静脉血栓形成和肺栓塞,膝关节对侧胫骨和髌股关节骨性关节炎的进展有无并发症。入院当天和术后第三天、第七天进行血常规,C反应蛋白(C-reactionprotein,CRP)和血沉(Equivalent Series Resistance,ESR)检查,比较两种术式在住院时间、血常规和CRP、ESR变化、出血量和血红蛋白较前变化值、疼痛评分、膝关节功能评分、HSS评分对比、膝关节内翻畸形矫正对比、体重、术中出血量的比较。采用SPSS19.0软件对以上数据进行统计分析,对两组数据进行t检验,检验差异是否具有统计学意义。了解膝关节骨性关节炎的治疗UKA是否可以表现出比TKA术后恢复快、创伤小的优点。结果单髁关节置换术可应用于单间室病变的治疗,这一点与TKA相似。从本研究可以得出结论,UKA改变了膝关节髌骨运动轨迹,使膝关节更有力,活动度更好。患者疼痛感觉可基本达到无痛,优良率可达100%,步态接近正常,行走可达2500-5000米且无需借助支具。UKA组术后一个月和术后三个月随访期间所进行的HSS评分高于TKA组。平均住院日方面UKA组平均住院日为5.73日,TKA组平均住院日为7.91日,UKA组较TKA组缩短,且病人住院费用也低于TKA组。术后恢复时间短,膝关节灵活度更高,疼痛缓解优良率高。UKA和TKA两组患者膝关节内翻畸形矫正对比、体重、术中出血量的比较显示UKA组内翻角(术前)平均为10.9+0.16°,内翻角(术后)3.3+0.33°,内翻角(矫正)6.7+0.67°,体重平均为71.2+0.67KG,术中出血量平均为115.8+0.83m L,与TKA相比较,UKA的优势在于术中出血少,术后引流量低,血红蛋白较前下降值低,提示恢复迅速。缺点是手术适应症较窄,内翻角矫正度数不如TKA,本研究中两组患者未发生并发症。UKA术后早期治疗效果值得肯定。结论UKA是有效的单间室病变的治疗方式,其优点是病人康复快、创伤小。与TKA比较该手术住院天数少、出血量少、术后并发症少。在术后减轻疼痛程度方面与TKA相比,UKA术后疗效好,患者满意度高。
[Abstract]:Single condylar knee arthroplasty (unicompartmental knee arthroplasty, UKA) is a common surgical method for the treatment of knee arthritis. Through the surface replacement of the interventricular disease, the degree of pain can be reduced and the normal physiological function of the knee joint is restored. It has the advantages of small trauma, less bone loss and light pain, and quick recovery after operation. It is a common operation for the treatment of osteoarthritis (total knee arthroplasty, TKA), which is widely used in clinical literature and is often reported in various literature, and is widely recognized as a gold mark for the treatment of serious knee joint lesions. In recent years, the prosthesis design is becoming mature, and the surgical instruments are constantly refurbished. In the case of reasonable mastery of the surgical technique, the significant improvement of the surgical effect has made UKA considerable progress in the treatment of knee osteoarthritis. The operation effect is satisfactory and the patient satisfaction is obviously improved. At the same time, the UKA preserves the bone quantity, keeps the normal anatomical relationship, the postoperative complications are few, the proprioception is good, and it has a good clinical application prospect. In 2013, this hand operation was carried out in our hospital, and the number of cases is still less, 12 cases through this article. In order to provide guidance for the treatment of this kind of patients in the future, 12 cases of UKA and 12 cases with similar pathological changes were analyzed and two kinds of hands were studied by analyzing the safety, the amount of trauma and the effect of clinical treatment in the treatment of single compartment disease. In the early postoperative treatment, the safety, the amount of trauma and the clinical effect of the knee osteoarthritis after the single compartment disease were compared and analyzed, and it was observed whether the patients who were confined to the single compartment were superior to UKA. Methods 24 cases of hospitalized patients from April 2013 to January 2015 were divided into two groups. The 12 patients with UKA were group UKA, TKA12 patients were group TKA, group UKA was 51-87 years old, 6 male patients, 6 female patients with the average age of 53-80 years, 6 male patients and 6 female patients. The above 24 patients were all patients with single compartment lesions of the knee osteoarthritis. The diagnostic criteria for the patients with single ventricular lesions were the affected area. It was limited to the medial compartment; a fixed flexion deformity less than 5 degrees; the active activity of the knee was at least 90 degrees; and the varus deformity was less than 15 degrees. The body conditions in the two groups were effectively controlled within the normal range. No excessive obesity, no inflammatory arthritis and multiple joint diseases, and no obvious resting pain. The joint flexion was at least 90 degrees and the joint activity was limited to varus 15 degrees. The lesion was mainly confined to the medial compartment of the knee. The first day, third days, seventh days after the operation, one month after the operation, and three months after the operation were analyzed and followed up. After the discharge, the outpatient and the patients or family members were called, and the imaging data after the operation were collected to check the patient's patient. Whether there were incisional infection, prosthesis loosening, sink or location, polyethylene liner dislocation, fracture of prosthesis, fracture, deep vein thrombosis of lower extremity and pulmonary embolism, the progress of the knee joint to the tibia and patellar joint osteoarthritis, the day of admission and third days after the operation, seventh days of blood routine, C reactive protein (C- Reactionprotein, CRP) and erythrocyte sedimentation rate (Equivalent Series Resistance, ESR), compared two kinds of surgical procedures in hospital time, blood routine and CRP, ESR change, bleeding volume and hemoglobin earlier change value, pain score, knee joint function score, HSS score comparison, knee arthrosis correction contrast, weight, intraoperative bleeding volume comparison. SPSS19. .0 software carries out statistical analysis of the above data and t tests of two groups of data to test whether the difference is statistically significant. To understand whether the treatment of osteoarthritis of the knee can show faster recovery and less trauma than TKA. Results single condylar arthroplasty should be used for the treatment of single compartment lesions, which is associated with TKA. It can be concluded from this study that UKA changes the track of the knee joint and makes the knee more powerful and more active. The pain sensation of the patient can be almost painless, the rate of good is up to 100%, the gait is close to normal, the walk is 2500-5000 meters, and it does not need the support of group.UKA after one month after the operation and the three month follow-up period after the operation. The HSS score was higher than that of the TKA group. The average hospitalization day in the group UKA was 5.73 days, the average hospitalization day in the group TKA was 7.91 days, the UKA group was shorter than the TKA group, and the hospitalization cost of the patients was lower than that of the TKA group. The postoperative recovery time was shorter, the flexibility of the knee joint was higher, the pain relief rate was higher in.UKA and TKA two groups of patients with knee varus deformity correction comparison. Heavy, intraoperative bleeding volume compared to the UKA group of varus angle (preoperative) average of 10.9+0.16 degrees, varus angle (post operation) 3.3+0.33 degrees, varus angle (Jiao Zheng) 6.7+0.67 degrees, average weight 71.2+0.67KG, intraoperative bleeding average of 115.8+0.83m L, compared with TKA, the advantage of UKA is less bleeding in the operation, lower flow rate after operation, lower hemoglobin than the former. The shortcoming is the rapid recovery. The shortcoming is that the operation is narrower and the correction degree of the varus angle is not as good as TKA. In this study, the early treatment effect of the two groups of patients without complications after.UKA is worth affirming. Conclusion UKA is an effective method for the treatment of the single compartment disease, its advantage is that the patient is quickly recovered and the wound is small. The number of hospitalized days is less than that of TKA, bleeding is less, bleeding is less. Less pain and less postoperative complications. Compared with TKA, postoperative pain relief is better than UKA.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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