【摘要】 [目的]比较单髁置换（unicompartmental knee arthroplasty, UKA）与胫骨高位截骨（high tibial osteotomy, HTO）治疗膝关节自发性骨坏死（spontaneous osteonecrosis of the knee, SONK）的临床疗效。[方法]回顾性分析2015年1月—2021年10月治疗的39例SONK患者的临床资料，根据术前医患沟通结果，22例行UKA治疗，17例行HTO治疗。比较两组围手术期、随访和影像资料。[结果]UKA组手术时间[(53.0±6.3) min vs (60.5±8.0) min, P<0.05]、术后下地时间[(3.5±0.9) d vs (5.7±0.7) d, P<0.05]均显著优于HTO组，但前者的切口总长度显著大于后者[(9.2±1.1) cm vs (6.7±0.9) cm, P<0.05]，两组术中失血量、切口愈合及住院时间的差异无统计学意义（P>0.05）。随访时间平均（24.7±10.0）个月，UKA组恢复完全负重活动时间显著早于HTO组[(7.1±2.0) d vs (34.5±3.6) d, P<0.05]。随时间推移，两组VAS评分、WOMAC评分、KSS评分均显著改善（P<0.05），膝ROM无显著变化（P>0.05）。术前两组上述指标的差异均无统计学意义（P>0.05），术后不同时间点UKA组的VAS评分、WOMAC评分、KSS评分均显著优于HTO组（P<0.05），但膝ROM比较差异无统计学意义（P>0.05）。影像方面，UKA组的FTA角术后即刻[(182.0±1.9)°vs (173.8±2.1)°, P<0.05]和末次随访[(182.0±1.7)°vs (173.0±2.0)°, P<0.05]均显著优于HTO组；末次随访时UKA组外侧室K-L分级[0/I/II/III/IV,(17/4/1/0/0) vs (6/7/4/0/0), P<0.05]及髌股室K-L分级[0/I/II/III/IV,(15/5/2/0/0) vs (4/8/4/1/0), P<0.05]均显著优于HTO组。[结论] UKA与HTO治疗SONK均能取得较好的临床疗效，但UKA组的早期临床疗效优于HTO组。更多还原

【Abstract】 [Objective] To compare the clinical outcomes of unicompartmental knee arthroplasty(UKA) versus high tibial osteotomy(HTO) for spontaneous osteonecrosis of the knee(SONK). [Methods] A retrospective study was conducted on 39 patients who received surgical treatment for SONK treated from January 2015 to October 2021. According to preoperative doctor-patient communication, 22 patients received UKA, while the other 17 patients received HTO. The perioperative, follow-up and imaging data were compared between the two groups. [Results] The UKA group proved significantly superior to the HTO group in terms of operating time [(53.0±6.3) min vs(60.5±8.0)min, P<0.05] and postoperative walking time [(3.5±0.9) days vs(5.7±0.7) days, P<0.05], despite of the fact that the former had significantly longer total incision length than the latter [(9.2±1.1) cm vs(6.7±0.9) cm, P<0.05]. However, there were no significant differences in intraoperative blood loss, incision healing grade and hospital stay between the two groups(P>0.05). All patients in both groups were followed up for(24.7±10.0) months on an average, and the UKA group returned to full weight-bearing activity significantly earlier than HTO group [(7.1±2.0) days vs(34.5±3.6) days, P<0.05]. The VAS, WOMAC and KSS scores were significantly improved in both groups over time(P<0.05),whereas the knee range of motion(ROM) was not significantly changed(P>0.05). Although there were no statistically significant differences in the above indexes between the two groups before surgery(P>0.05), the UKA group was significantly better than the HTO group in terms of VAS score, WOMAC score and KSS scores at all time points postoperatively accordingly(P<0.05), while without statistically significant differences in knee ROM between the two groups(P>0.05). Radiographically, the UKA group had significantly better femorotibial angle(FTA)than the HTO group immediate postoperatively [(182.0±1.9)° vs(173.8±2.1)°, P<0.05] and at the last follow-up [(182.0±1.7)° vs(173.0±2.0)°, P<0.05]. In addition, the UKA group proved significantly superior to the HTO group at the latest follow-up in terms of the lateral compartment Kellgren and Lawrence(K-L) classification [0/I/II/III/IV,(17/4/1/0/0) vs(6/7/4/0/0), P<0.05] and patellofemoral K-L classification[0/I/II/III/IV,(15/5/2/0/0) vs(4/8/4/1/0), P<0.05]. [Conclusion] Both UKA and HTO do achieve good clinical outcomes for treatment of SONK. By comparison, the UKA has considerably better early clinical consequence than the HTO.更多还原