广西医学

目的探讨单髁关节置换术（UKA）与全膝关节置换术（TKA）治疗塌陷期膝关节自发性骨坏死（SONK）患者的临床效果。方法选取80例塌陷期SONK患者作为研究对象，采用随机数表法将患者分为UKA组（接受UKA治疗）和TKA组（接受TKA治疗），每组40例。记录两组患者的手术相关指标和术后并发症，分别于术前、出院时、术后1个月、术后3个月及术后6个月采用视觉模拟量表（VAS）评估患者的疼痛程度，采用美国特种外科医院（HSS）膝关节评分、牛津大学膝关节评分（OKS）、美国膝关节协会（AKS）评分评估患者的膝关节功能，采用健康调查12项简表（SF-12）评价患者的生活质量，并测量患者的膝关节屈曲度、伸直活动度。结果 UKA组的手术时间、切口长度、围手术期出血量、首次下床活动时间、直腿抬高活动时间、屈膝90 °活动时间、术后住院时间均短于或少于TKA组（P<0.05）。出院时及术后1个月、3个月、6个月，两组患者的VAS评分较术前降低，HSS膝关节评分、OKS、AKS评分、SF⁃12评分较术前升高（P<0.05），但两组患者间差异无统计学意义（P>0.05）；出院时及术后1个月、3个月、6个月，两组患者的膝关节屈曲度、伸直活动度较术前增大，且UKA组膝关节屈曲度、伸直活动度大于TKA组（P<0.05）。两组患者的术后并发症发生率差异无统计学意义（P>0.05）。结论对于塌陷期SONK患者，UKA与TKA在疼痛缓解和膝关节功能恢复方面效果相当，但UKA较TKA可获得更大的膝关节活动范围，患者术后恢复更快。

Objective To investigate the clinical effect of unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA) for the treatment of spontaneous osteonecrosis of the knee (SONK) in collapse stage. Methods A total of 80 SONK patients in collapse stage were selected as the research subjects, and they were randomly divided into UKA group (receiving UKA treatment) or TKA group (receiving TKA treatment) by the random number table method, with 40 cases in each group. Indices related to surgery and postoperative complications of both groups were recorded. Before surgery, at discharge, and 1, 3, and 6 months after surgery, pain degree of patients was evaluated by using Visual Analogue Scale (VAS); moreover, knee joint score of Hospital for Special Surgery (HSS), Oxford Knee Score (OKS), and American Knee Society (AKS) score were adopted to evaluate functions of knee joint in patients; in addition, the 12⁃Item Short Form Health Survey (SF⁃12) was employed to evaluate quality of life in patients, and flexion and straight raising range of motion of knee joint in patients were measured. Results The operation duration, incision length, perioperative bleeding volume, first time to out⁃of⁃bed activity, straight leg raising activity time, knee flexion 90° activity time, and postoperative length of hospital stay in the UKA group were shorter/less than those in the TKA group (P<0.05). At discharge, and 1, 3, and 6 months after operation, the VAS score of the two groups was lower than that before operation, and HSS knee joint score, OKS, AKS score, SF⁃12 score were higher than those before operation (P<0.05), but there was no statistically significant difference between the two groups (P>0.05). At discharge, and 1, 3, and 6 months after operation, the flexion and straight raising range of motion of knee joint in the two groups were increased as compared with before operation, and those in the UKA group were greater than those in the TKA group (P<0.05). There was no statistically significant difference in the incidence rate of postoperative complications between the two groups (P>0.05). Conclusion UKA and TKA have similar effects in pain relief and knee function recovery, but UKA can obtain a larger knee range of motion and faster postoperative recovery than TKA among SONK patients in collapse stage.