类风湿性关节炎下肢畸形手术顺序选择的初步经验  

Preliminary Experience on Selection of Sequenceof Operations for Rheumatoid Arthritis Patients withPolyarticul ar Deformities of the Lower Extremities

作　　者：吕厚山[1] 陈晓欣[1] 林剑浩[1] 袁燕林[1] 高彤[1] 

机构地区：[1]北京医科大学人民医院关节病诊疗中心

出　　处：《中华骨科杂志》1995年第8期483-486,共4页Chinese Journal of Orthopaedics

摘　　要：复习１８例下肢多关节严重畸形的类风湿性关节炎病人手术治疗的初步经验，所有病人均有双侧人工全膝和全髋关节置换术的指征，除两例同时行一侧髋、膝关节置换术外，其余病人均只行人工全膝关节置换术，平均随访３６．３个月，采用文献中现有的评分方法，发现所有病人的病情均有明显改善。作者认为，人工全关节置换术在治疗严重类风湿性关节炎畸形的过程中，疗效是肯定的，但中晚期并发症较多，最大限度地推迟手术，并减少手术关节数目，手术时应在手术顺序和术式选择上认真研究，只要髋关节尚未强直，不是影响病人生活自理的关键部位，而膝关节是影响下肢功能最重要的因素时，应先行膝关节置换术，尤其是年龄比较小的病人更应如此。AbstractA series of 18 rheumatoid arthritis(RA) patientswith severe deformities of the lower extremities wereincluded in this study. Bilateral total knee and hiparthroplasty , or four-joint arthroplasty(FJA)wereindicated for them according to the previously well-es-tablished operative indication. Only total knee arthro-plasties(TKAs ) were performed for these patients,except that 2 patients undertook ipsilateral total hipand knee arthroplasty(lJA) in both side. Using sever-al rating scales appeared in the previous literature,wefound that the improvement of function and pain relief-were achieved in all of them after a mean follow-up pe-riod of 30. 3 months,We believe , TJA has been doneoverzealously for RA patients.FJA or lJA is not al-ways as successful as expected. Possible delay ofTJA,especially FJA and IJA is mandatory. An opera-tive scheme should be as simple as possible, cost-ef-fective and reasonable. TKA prior to THA is feasiblefor those whose hip is not severely symptomatic andnon-ankyiosed while the knee is the most severely in-volved joint , and FJA or lJA is not indicated due toother causes, especially when the patient is young.

关 键 词：人工关节置换术 类风湿关节炎 下肢畸形 

分 类 号：R593.220.6[医药卫生—内科学] R682.605[医药卫生—临床医学]