目的 探讨微创单髁置换术和胫骨高位截骨治疗自发性膝关节骨坏死患者临床疗效。方法 选取2018年1月-2019年12月我院收治的自发性膝关节骨坏死患者98例，根据随机数表法分为单髁置换术组（49例）和胫骨高位截骨组（49例），分别采用微创单髁置换术和胫骨高位截骨治疗，比较两组临床疗效，并对两组手术相关指标进行比较，观察两组治疗前后Tegner评分、Lysholm评分和VAS评分，并对治疗前后两组步态指标进行比较。结果 单髁置换组治疗有效率（93.88%）高于胫骨高位截骨组（81.63%），差异有统计学意义（χ2=7.852，P=0.020）。单髁置换组手术时间、术中出血量、下床活动时间、住院时间均明显少于胫骨高位截骨组，差异有统计学意义（t=8.283、5.293、49.290、25.067，P=0.000）。治疗前两组患者Tegner评分与Lysholm评分无明显差异（P>0.05）；治疗后两组患者Tegner评分和Lysholm评分均明显升高，差异有统计学意义（P<0.05）。但单髁置换组和胫骨高位截骨组Tegner评分与Lysholm评分差异无统计学意义（P>0.05）。手术前两组VAS评分无明显差异（P>0.05）；术后1月和术后3月单髁置换组VAS评分明显低于胫骨高位截骨组，差异有统计学意义（t=10.461、15.537，P=0.000）。治疗前两组患者步速、步长、步频、双支撑相无明显差异（P>0.05）；治疗后单髁置换组步速、步长和步频明显增加，双支撑相比例明显减少，且单髁置换组增加/减少程度较胫骨高位截骨组明显，差异有统计学意义（P<0.05）。结论 与胫骨高位截骨术相比，微创单髁置换术具有出血量少、住院时间短、膝关节评分较高等特点，且患者疼痛程度更低，值得骨科进一步推广应用。

Objective Investigate the clinical effect of minimally invasive mononcondyle replacement and high tibial osteotomy on spontaneous osteonecrosis of the knee.Methods Selection in January 2018 - December 2019, our hospital 98 cases of patients with spontaneous osteonecrosis of knee joint, based on the stochastic indicator method is divided into single condylar replacement group (49 cases) and high tibia bone cutting group (49 cases), respectively using minimally invasive replacement single condyle and high tibia bone cutting treatment, compared two groups of clinical curative effect, and carries on the comparison to two groups of indicators related to the operation, observe the two groups before and after treatment Tegner score, Lysholm score and VAS score, and carries on the comparison to two groups of gait indexes before and after treatment.Results The effective rate of unicondylar replacement group (93.88%) was higher than that of the high tibial osteotomy group (81.63%), and the difference was statistically significant (χ2=7.852, P=0.020). The operative time, intraoperative blood loss, ambulation time and hospital stay time of the monondylar replacement group were significantly lower than those of the high tibial osteotomy group, with statistically significant differences (T =8.283, 5.293, 49.290, 25.067, P=0.000). Before treatment, there was no significant difference between Tegner score and Lysholm score (P>0.05). After treatment, Tegner score and Lysholm score in both groups were significantly increased, and the difference was statistically significant (P<0.05). However, there was no significant difference between Tegner score and Lysholm score in the unicondylar replacement group and the high tibial osteotomy group (P>0.05). There was no significant difference in VAS scores between the two groups before surgery (P>0.05). VAS scores of the monocondylar replacement group were significantly lower than those of the high tibial osteotomy group 1 month and 3 months after surgery, and the difference was statistically significant (T =10.461, 15.537, P=0.000). Before treatment, there was no significant difference in step speed, step length, step frequency or double support phase between the two groups (P>0.05). After treatment, the step speed, step length and step frequency of the unicondylar replacement group were significantly increased, while the ratio of double support phase was significantly decreased, and the increase/decrease degree of the unicondylar replacement group was significantly higher than that of the high tibial osteotomy group, with statistically significant difference (P<0.05).Conclusion Compared with high tibial osteotomy, minimally invasive monocondylar replacement has the characteristics of less bleeding, shorter hospital stay, higher knee score, and lower pain degree of patients, which is worthy of further promotion and application of orthopedics.