[Effect of unicompartmental knee arthroplasty in patients over 75 years old with knee osteoarthritis].

OBJECTIVE: To investigate the clinical effect of unicompartmental knee arthroplasty in patients with knee osteoarthritis over 75 years old. METHODS: From April 2010 to May 2015, 42 patients with knee medial compartment osteoarthritis were treated with Oxford third-generation unicompartmental knee arthroplasty. According to the single and bilateral replacement, the patients were divided into bilateral simultaneous replacement group and unilateral replacement group:11 patients in the simultaneous replacement group, 3 males and 8 females, aged (79.18±3.06) years;There were 31 cases in the unilateral replacement group, 13 males and 18 females, aged (78.16±3.48) years. The survival status of patients with knee prosthesis, the changes of hematocrit before and after operation, and the total amount of blood loss during and after operation were observed and compared;The HSS (Hospital for Special Surgery knee rating) scores of patients before and after operation were compared. RESULTS: There was significant difference in perioperative complications between two groups(P<0.05). All 42 patients were followed up for(5.7±2.3) years. One patient with a history of previous hypertension developed cerebral thrombosis in the 4th month after operation, one patient developed pad dislocation in the 4th month after operation, and two patients died of other medical diseases(1 myocardial infarction and 1 lung cancer) 3 years after operation. The total amount of postoperative blood loss in bilateral simultaneous replacement group was higher than that in unilateral replacement group(P<0.05);Four patients with bilateral simultaneous replacement received 2U blood transfusion after operation. The HSS score and total score of the two groups at 9 months after operation were higher than those before operation(P<0.05). CONCLUSION: Unicompartmental knee arthroplasty is a feasible surgical treatment for osteoarthritis patients over 75 years old with medial single compartment degeneration. For elderly patients over 75 years old with bilateral knee lesions, bilateral simultaneous unicompartmental knee arthroplasty is more traumatic than unilateral unicompartmental knee arthroplasty, which will increase the incidence of perioperative complications, affect the rapid postoperative recovery and increase the blood loss. Although the long-term effect is equivalent to that of unilateral unicompartmental knee arthroplasty, staged operation is still recommended to ensure the safety of operation.

[Clinical efficacy and technical characteristics of percutaneous endoscopic lumbar discectomy in the treatment of upper lumbar disc herniation].

OBJECTIVE: To analyze the clinical efficacy and technical characteristics of percutaneous endoscopic lumbar discecomy in the treatment of upper lumbar disc herniation. METHODS: The clinical data of 9 patients with upper lumbar disc herniation underwent percutaneous endoscopic lumbar discecomy from January 2012 to October 2019 were retrospectively analyzed. There were 6 males and 3 females, aged 26 to 79 years, including 2 patients with L1,2 disc herniation and 7 patients with L2, 3 disc herniation. Visual analogue scale (VAS) and Japanese Orthopeadic Association (JOA) score were recorded before and after surgery. The clinical efficacy was evaluated according to the modified Macnab standard. RESULTS: All 9 patients were followedup, and the follow-up time was 1 day and 3 months after surgery. The operation time was 1.5 to 2.9 h and postoperative hospital stay was 5 to 8 d. No cerebrospinal fluid leakage or spinal cord injury occurred during the operation. Preoperative and postoperative at 1 day, 3 months, the VAS scores of 9 patients were 7 to 8 scores, 1 to 3 scores, 0 to 1 case, JOA scores were 5 to 7 scores, 15 to 24 scores, 21 to 26 scores, respectively. The improvement rate of JOA was 36.4% to 78.3% on the first day and 65.2% to 87.5% three months after operation. According to modified Macnab standard to evaluate effect, 4 cases got excellent results, 4 good, 1 fair. CONCLUSION: Percutaneous endoscopic lumbar discecomy has reliable therapeutic effect for upper lumbar disc herniation in line with the indications, and it has the characteristics of small trauma and short operation time, so it is more suitable for middle aged and elderly patients with poor physique and can replace part of transforaminal lumbar interbody fusion.