本文關(guān)鍵詞： 膝關(guān)節(jié)骨性關(guān)節(jié)炎 單髁置換術(shù) 全膝置換術(shù) 臨床近期療效　出處：《南京中醫(yī)藥大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：通過(guò)觀察單髁置換術(shù)(UKA)和全膝置換術(shù)(TKA)治療膝關(guān)節(jié)骨性關(guān)節(jié)炎的近期臨床療效對(duì)比,來(lái)確定單髁的臨床療效,為其臨床推廣提供實(shí)踐依據(jù)。方法：患者均來(lái)自南京中醫(yī)藥大學(xué)附屬常州市中醫(yī)院2013年9月～2014年10月骨傷科住院病人。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)。觀察手術(shù)創(chuàng)傷指標(biāo)(出血量、手術(shù)時(shí)間、膝關(guān)節(jié)屈曲90°的時(shí)點(diǎn)、膝關(guān)節(jié)腫脹度),做出比較。最后,手術(shù)前后兩組患者的VAS評(píng)分、膝關(guān)節(jié)最大屈曲度、KSS. WOMAC評(píng)分統(tǒng)計(jì)分析來(lái)比較其臨床療效,兩組患者的隨訪(fǎng)時(shí)間均為6個(gè)月。結(jié)果：1、創(chuàng)傷指標(biāo)：①出血量(總引流量)：?jiǎn)西两M的出血量(180.0±30.332)ml明顯小于全膝組的(406.6±87.108)毫升。②手術(shù)時(shí)間：?jiǎn)西劣捎谥皇菍?duì)半個(gè)間室進(jìn)行置換,其所用時(shí)間(37.73±6.467)分少于全膝所用時(shí)間(67.08±6.895)分。③膝關(guān)節(jié)屈曲90°時(shí)點(diǎn)：?jiǎn)西两M所用時(shí)間為(5.45±0.473)天少于全膝的(8.42±2.065)天。④關(guān)節(jié)腫脹度(膝關(guān)節(jié)周徑)：術(shù)后1周、2周單髁組(44.45±1.214、40.00±0.894)厘米都小于全膝組(46.00±1.706、41.92±0.996)厘米,3個(gè)月后無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2、①UKA組11例和TKA組12例患者都取得了比較滿(mǎn)意的臨床療效。術(shù)后切口都是I/甲愈合,未出現(xiàn)感染、下肢深靜脈血栓、假體松動(dòng)等并發(fā)癥。②UKA組和TKA組術(shù)前的VAS、膝關(guān)節(jié)最大屈曲度、KSS和WOMAC評(píng)分均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者術(shù)前無(wú)顯著差異。③VAS評(píng)分：UKA組的VAS由術(shù)前的(7.64±0.92)分降到術(shù)后末次隨訪(fǎng)的(2.09±0.83)分,TKA組的VAS由術(shù)前的(7.58±0.90)分降到術(shù)后末次隨訪(fǎng)的(2.67±0.89)分,兩組患者疼痛緩解明顯,但是末次隨訪(fǎng)時(shí)UKA組優(yōu)于TKA組(P0.05)。④膝關(guān)節(jié)最大屈曲度,：末次隨訪(fǎng)時(shí)UKA組(122.73±5.17)度明顯優(yōu)于TKA組(118.25±3.864)度(P＜0.01), ⑤KSS臨床、功能評(píng)分：末次隨訪(fǎng),兩組患者術(shù)后臨床和功能評(píng)分都有提高,UKA組分別為(89.72±1.42)、(89.18±1.66)分,TKA組分別為(86.58±1.83)、(84.91±1.62)分(P0.01)。⑥WOMAC評(píng)分：末次隨訪(fǎng)時(shí)UKA組(6.18±0.98)分優(yōu)于TKA組的(7.91±1.08)分(P0.01)。結(jié)論：UKA、TKA對(duì)于單側(cè)間室骨性關(guān)節(jié)炎均取得了滿(mǎn)意的療效,UKA由于創(chuàng)傷小、手術(shù)時(shí)間短、恢復(fù)快等優(yōu)點(diǎn),只要把握適應(yīng)癥,UKA的術(shù)后近期療效可以?xún)?yōu)于TKA,值得臨床推廣。
[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 擄, 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 鹵30.332 ml in the single condyle group was significantly lower than 406.6 鹵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 鹵87.108 ml). The time taken was 37.73 鹵6.467) less than that of the whole knee (67.08 鹵6.895). The time of knee flexion 90 擄in the single condyle group was 5.45 鹵0.473 days, which was less than 8.42 鹵2.065 days in the whole knee. 4. 4 degree of joint swelling (the circumference of knee joint: 44.45 鹵1.214v 40.00 鹵0.894cm in the moncondylar group 1 week after operation and 2 weeks after operation). Less than 46.00 鹵1.706 鹵41.92 鹵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 鹵0.92 before operation to the last follow-up after operation. The VAS of TKA group decreased from 7.58 鹵0.90 before operation to 2.67 鹵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 鹵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 鹵1.42OU (89.18 鹵1.66) and the score of TKA group was 86.58 鹵1.83 (84.91 鹵1.62WMAC). The score of UKA group (6.18 鹵0.98) was better than that of TKA group (6.18 鹵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.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R274.9

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