内侧单髁置换术治疗高龄内侧间室膝骨关节炎合并前交叉韧带损伤的短期临床疗效研究

Short-Term Clinical Efficacy of Medial Unicompartmental Knee Arthroplasty in Elderly Patients with Medial Compartment Knee Osteoarthritis Combined with Degenerative Anterior Cruciate Ligament Injury

摘要: 目的：探讨内侧单髁置换术(medial unicompartmental knee arthroplasty, UKA)应用于高龄内侧间室膝骨关节炎(knee osteoarthritis, KOA)合并前交叉韧带(anterior cruciate ligament, ACL)损伤患者的短期临床疗效，评估该术式在此类患者中的短期安全性与有效性，为临床个体化术式选择提供参考。方法：回顾性纳入2021年1月至2025年12月于本院骨科接受手术治疗的30例高龄内侧间室KOA患者作为研究对象，依据是否合并退变性ACL损伤分为单纯KOA组(单纯内侧间室KOA，n = 15)与ACL损伤组(内侧间室KOA合并ACL损伤，n = 15)。对比分析两组基线临床资料、围手术期相关指标，分别于术前及术后1、3、6个月采集两组视觉模拟评分(VAS)、美国特种外科医院膝关节评分(HSS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)，并统计术前及术后6个月膝关节屈曲活动度改善情况。采用Shapiro-Wilk检验完成计量资料正态性检验，针对3项主要结局指标共计12次组间重复对比，采用Bonferroni法调整检验水准以控制多重比较的I类错误，作为敏感性分析指标，同时报告未校正与校正后的P值，以供临床参考。结果：两组患者年龄、性别、体质量指数等基线临床资料对比，差异无统计学意义(P > 0.05)；ACL损伤组术前病程显著长于单纯KOA组，差异存在统计学意义(U = 58.00, P = 0.02)，为潜在基线混杂因素。组内分析结果显示，两组患者术后各随访时间点VAS、WOMAC评分较术前显著降低，HSS评分较术前显著升高，差异均具备统计学意义(均P < 0.001)。多重比较校正前，ACL损伤组术后1个月VAS评分、术后6个月WOMAC评分高于单纯KOA组；经Bonferroni多重比较校正后，上述组间差异均无统计学意义。两组术前及术后各随访节点的膝关节疼痛程度、关节功能、屈曲活动度相关指标组间对比，差异均无统计学意义(P > 0.05)。结论：针对高龄内侧间室KOA合并轻度退变性ACL损伤患者，内侧UKA可获得稳定的短期临床预后，可有效缓解膝关节疼痛、改善膝关节功能与活动范围。在严格把握手术适应证、完善术前膝关节稳定性评估的前提下，合并轻度退变性ACL损伤不影响UKA短期疗效，但上述结论需更大样本量、多中心研究进一步验证。

Abstract: Objective: To investigate the short-term clinical efficacy of medial unicompartmental knee arthroplasty (UKA) in the treatment of elderly patients with medial compartment knee osteoarthritis (KOA) complicated by anterior cruciate ligament (ACL) injury, and to systematically evaluate the clinical safety and efficacy of this surgical procedure, so as to provide an evidence-based reference for clinical individualized surgical selection. Methods: A total of 30 elderly patients with medial compartment KOA who underwent surgical treatment in the Department of Orthopedics of our hospital from January 2021 to December 2025 were retrospectively enrolled in this study. All subjects were divided into the isolated medial KOA group (isolated medial compartment KOA, n = 15) and the ACL injury group (medial compartment KOA combined with degenerative ACL injury, n = 15) according to the presence or absence of degenerative ACL injury. Baseline clinical data and perioperative indicators were compared between the two groups. Visual analogue scale (VAS), Hospital for Special Surgery (HSS) score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were collected at baseline and 1, 3, 6 months postoperatively, and the improvement of knee flexion range of motion before and 6 months after surgery was statistically analyzed. Shapiro-Wilk test was adopted for normality verification of measurement data, and Bonferroni method was used to correct the test level for 12 repeated inter-group comparisons of three primary outcome indicators. Results: There were no significant differences in baseline data including age, gender and body mass index between the two groups (P > 0.05). The preoperative symptom duration of the ACL injury group was significantly longer than that of the isolated medial KOA group (U = 58.00, P = 0.02). Intra-group analysis demonstrated that VAS and WOMAC scores were significantly decreased, while HSS scores were significantly increased at each postoperative follow-up time point in both groups (all P < 0.001). Before multiple comparison correction, the ACL injury group presented higher VAS score at 1 month and higher WOMAC score at 6 months after surgery, whereas no significant inter-group differences were observed after Bonferroni correction. No significant differences in knee pain severity, joint function and range of motion were found between the two groups at all follow-up time points (P > 0.05). Conclusion: Medial UKA can achieve stable short-term clinical outcomes in elderly patients with medial compartment KOA combined with mild degenerative ACL injury, which can effectively alleviate knee pain and improve knee joint function and range of motion. With strict adherence to surgical indications and precise preoperative evaluation of knee stability, mild degenerative ACL injury does not affect the short-term efficacy of UKA, but the above conclusions need to be further verified by larger sample size and multi-center studies.