来源：304关节学术

译者：张轶超

整理：骨科在线

2017年H Siman等在线发表于《J Arthroplasty》杂志的一项研究显示，对于大于75岁的老年单纯内侧间室骨关节炎患者，全膝关节置换术（TKA）与单髁置换术（UKA）在并发症发生率和中期生存率没有显著差别。由于UKA手术本身创伤小，患者恢复更快，对于老年有适应证的患者，UKA是一个更好选择。

既往的研究对比了老年人做UKA和TKA之间的效果，而这些研究大多是以关节疾病的种类和病人的情况作为比较分组的依据。此项研究对象是大于75岁的单纯内侧间室骨关节炎患者，着重观察其术后短期恢复情况，并发症情况，再手术率及假体中期生存率。

研究人员回顾了从2002年到2012年，在梅奥医学中心完成的所有大于等于75岁的UKA和TKA患者。所有做了TKA的患者都由一位不知情的第三方医生对其术前X光片进行阅读，确定这些患者由于是内侧间室骨关节炎而适合行UKA手术。至少随访2年，屈曲挛缩超过10°及类风湿性关节炎除外。最终得到观察的有120例UKA（106名患者）和188例TKA（170名患者）。记录术后的恢复情况，并发症，各种原因的再手术情况及假体生存率。

结果显示，UKA患者的手术时间明显短，住院时间短，术中出血少，术后输血少，拥有更好的术后活动度，出院时活动水平更高。2名UKA患者及2名TKA患者需要进行翻修。两者术后膝关节协会评分没有明显差异。5年生存率两者间没有差异。

原文：

Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty for Medial CompartmentArthritis in Patients Older Than 75 Years: Comparable Reoperation, Revision, and ComplicationRates

BACKGROUND:

Prior studies comparing unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) in the elderly are limited by heterogeneity in arthritic disease patterns and patient selection. We report the results of UKA and TKA in patients 75 years and older with isolated medial compartmental arthritis, with special emphasis on immediate postoperative recovery, complications, reoperationrates, and implant survivorship at midterm follow-up.

METHODS:

A retrospective review was performed of all patients 75 years and older who underwent UKA or TKA at our institution between 2002 and 2012. All TKA preoperative X-rays were reviewed by a blind observer to identify knees with isolated medial compartmental arthritisconsidered acceptable candidates for UKA. Patients with less than 2 years of follow-up, flexion contracture greater than 10°, and rheumatoid arthritis were excluded. The final sample included 120 UKA (106 patients) and 188 TKA (170 patients) procedures. Patient records were reviewed to determine early postoperative recovery, complications, reoperations for any reason, and implant survivorship.

RESULTS:

UKA patients experienced significantly shorter operative time, shorter hospital stay, lower intraoperative estimated blood loss, lower postoperative transfusions, greater postoperative range of motion, and higher level of activity at time of discharge. Two UKA and 2 TKA patients required revision surgery. There was no statistically significant difference in postoperative Knee Society Scores. There were no differences in 5-year survivorship estimates.

CONCLUSION:

Due to its less invasive nature, patients older than 75 undergoing UKA demonstrated faster initial recovery when compared to TKA, while maintaining comparable complications and midterm survivorship. UKA should be offered as an option in the elderly patient who fits the selection criteria for UKA.

文献出处：

Siman H, Kamath AF, Carrillo N, Harmsen WS, Pagnano MW, Sierra RJ. Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty for Medial CompartmentArthritis in Patients Older Than 75 Years: Comparable Reoperation, Revision, and ComplicationRates. J Arthroplasty. 2017 Jun;32(6):1792-1797.