高龄膝骨关节炎患者人工单髁关节置换疗效分析

目的:探讨75岁以上膝骨性关节炎患者行人工单髁关节置换术后临床疗效。方法：自2010年4月至2015年5月应用Oxford第3代人工单髁关节治疗膝内侧间室骨性关节炎患者42例，根据手术单双侧置换情况将患者分为双侧同期置换组和单侧置换组：同期置换组11例，男3例，女8例，年龄（79.18±3.06）岁；单侧置换组31例，男13例，女18例，年龄（78.16±3.48）岁。观察比较患者患膝假体生存现状、术前后血细胞比容变化、术中及术后的失血总量，比较患者术前后膝关节HSS（Hospital for Special Surgery knee-rating）评分。结果：两组术后围手术期并发症比较差异有统计学意义（P<0.05）。42例患者获得随访，时间（5.7±2.3）年。1例既往高血压合病史患者术后第4个月发生脑血栓，1例患者在术后第4个月发生衬垫脱位，2例患者于术后3年因其他内科疾病死亡（1例心肌梗塞，1例肺癌）。双侧同期置换组术后失血总量高于单侧置换组（P<0.05）；4例行双侧同期置换患者术后分别输血2 U。两组术后9个月HSS评分除稳定性评分其他各项评分和总分均高于术前（P<0.05）。结论：内侧单间室退变的75岁以上老年骨性关节炎患者选择人工单髁关节置换术是可行的手术治疗方法。对于双膝病变75岁以上老年患者，双侧同期人工单髁关节置换术同单侧单髁关节置换手术相比，创伤大，会增加围手术期并发症发生率，影响术后快速康复，增加失血量。虽然远期疗效同单侧单髁关节置换手术相当，但为保证手术安全性，仍建议分期手术。

Effect of unicompartmental knee arthroplasty in patients over 75 years old with knee osteoarthritis

Objective: To investigate the clinical effect of unicompartmental knee arthroplasty in patients with knee osteoarthritis over 75 years old.Methods: From April 2010 to May 2015, 42 patients with knee medial compartment osteoarthritis were treated with Oxford third-generation unicompartmental knee arthroplasty. According to the single and bilateral replacement, the patients were divided into bilateral simultaneous replacement group and unilateral replacement group:11 patients in the simultaneous replacement group, 3 males and 8 females, aged (79.18±3.06) years;There were 31 cases in the unilateral replacement group, 13 males and 18 females, aged (78.16±3.48) years. The survival status of patients with knee prosthesis, the changes of hematocrit before and after operation, and the total amount of blood loss during and after operation were observed and compared;The HSS (Hospital for Special Surgery knee rating) scores of patients before and after operation were compared.Results: There was significant difference in perioperative complications between two groups(P<0.05). All 42 patients were followed up for(5.7±2.3) years. One patient with a history of previous hypertension developed cerebral thrombosis in the 4th month after operation, one patient developed pad dislocation in the 4th month after operation, and two patients died of other medical diseases(1 myocardial infarction and 1 lung cancer) 3 years after operation. The total amount of postoperative blood loss in bilateral simultaneous replacement group was higher than that in unilateral replacement group(P<0.05);Four patients with bilateral simultaneous replacement received 2U blood transfusion after operation. The HSS score and total score of the two groups at 9 months after operation were higher than those before operation(P<0.05).Conclusion: Unicompartmental knee arthroplasty is a feasible surgical treatment for osteoarthritis patients over 75 years old with medial single compartment degeneration. For elderly patients over 75 years old with bilateral knee lesions, bilateral simultaneous unicompartmental knee arthroplasty is more traumatic than unilateral unicompartmental knee arthroplasty, which will increase the incidence of perioperative complications, affect the rapid postoperative recovery and increase the blood loss. Although the long-term effect is equivalent to that of unilateral unicompartmental knee arthroplasty, staged operation is still recommended to ensure the safety of operation.