类风湿关节炎下肢多关节置换后的功能效果评价  

Evaluation on functional outcome of multiple-joint replacement in patients with rheumatoid arthritis in lower extremities

作　　者：王黎明[1] 桂鉴超[1] 宋华荣[1] 黄河[1] 候明夫[1] 

机构地区：[1]南京医科大学附属南京第一医院骨科,江苏省南京市210006

出　　处：《中国临床康复》2006年第28期31-33,i0001,共4页Chinese Journal of Clinical Rehabilitation

基　　金：南京市外国专家局基金资助项目(G200232100)~~

摘　　要：目的:评价类风湿关节炎患者下肢多关节置换术后的功能效果。方法:选择1999-04/2003-10在南京医科大学附属南京第一医院就诊的下肢多关节受累的晚期类风湿关节炎患者39例,均自愿参加观察,病程5～18年。2例患者行下肢四关节一期同时置换,4例患者行下肢三关节一期同时置换,3例患者行一侧髋、膝关节同时置换,21例患者行双侧髋或膝关节同时置换,7例患者行一期双侧髋关节同时置换、二期双侧膝关节置换,1例患者行一期双侧膝关节同时置换、二期一侧髋关节置换,1例患者行一期双侧膝关节同时置换、二期双侧髋关节置换。共计103个关节,其中46个髋关节,57个膝关节;四关节置换10例,三关节置换5例,两关节置换24例。分期手术间隔时间为15d～12.5个月。分别记录患者对手术的满意度(分为4级,Ⅰ级为差,Ⅱ级为一般,Ⅲ级为良,Ⅳ级为优)。结果:39例患者全部进入结果分析,无脱落。所有病例平均随访48.3个月。本组术后患者主观满意度达到Ⅲ～Ⅳ级29例,占89.7%。①2例下肢四关节一期置换者均为25～30岁的年轻人,满意度为Ⅳ级。②4例下肢三关节一期置换者中,3例年龄在40～60岁之间,满意度Ⅳ级;1例为74岁老人,发生髋关节感染,经病灶清除、置管冲洗后3年再复发,最后并发肺部感染而死亡,患者满意度差。③下肢分期手术9例患者中,年龄在55～75岁之间,6例术后主观满意度Ⅳ级,2例Ⅲ级,1例Ⅱ级。④24例行一期两个关节置换,18例术后主观满意度Ⅳ级,4例Ⅲ级,2例为一般。结论:年轻、关节受累数目少、全身情况好的患者的术后满意度明显优于年老、关节受累数目多、全身情况差者。类风湿关节炎下肢多关节病变应尽早手术治疗,且手术方法应做到个体化。AIM： To evaluate the functional effects of multiple-joint replacement on patients with rheumatoid arthritis （RA） in lower extremities. METHODS： A total of 39 patients with RA in multiple-joint of lower extremitis at the advanced stage from April 1999 to October 2003 were selected from Nanjing First Hospital of Nanjing Medical University. The subjects all took part in the study voluntarily and had a course of disease ranged 5-18 years. Two patients received four-joint replacement in lower extremities simultaneously at the first stage, 4 patients received simultaneous replacements of three joints at the first stage, 3 received replacements of ipsilateral hip and knee joint simultaneously, 21 received replacements of bilateral hips or knee joint simultaneously at the first stage. Simultaneous bilateral hip replacement at the first stage and bilateral knee replacement at the second stage were performed on 7 patients, and bilateral knee replacement at the first stage followed by hip replacement at the second stage was given to 1 patient. One patient received simultaneous bilateral knee replacements at the first stage followed by bilateral hip replacements at the second stage. A total of 103 joints （46 hips, 57 knees） were replaced, including 10 four-joint replacements, 5 three-joint replacements and 24 two-joint replacements. The interval between staging operation ranged from 15 days to 12.5 months. The satisfaction degree of patients were recorded （there were 4 grades in all, Ⅰ signified poor, Ⅱ general, Ⅲ good and Ⅳ excellent）. RESULTS： A total of 39 patients were involved in the analysis of results, and no one withdrew from the study. The average time of follow-up was 48.3 months. The subjective satisfaction degree of 29 patients （89.7%） ranged Ⅲ-Ⅳ.（1）Two patients, who received four-joint replacement in lower extremities at the first stage were （25-35） years old and their satisfaction gradewas Ⅳ. （2）Among 4 patients who received three-joint replacements simultane

关 键 词：关节炎 类风湿 关节成形术 置换 评价研究 

分 类 号：R593.22[医药卫生—内科学]