全膝关节置换术治疗甲型血友病膝关节病变的疗效分析  

Outcome of total knee arthroplasty for end-stage type A hemophilic arthropathy

作　　者：冯宾[1] 翁习生[1] 林进[1] 翟吉良[1] 钱文伟[1] 盛林[1] 边焱焱[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院骨科,北京100730

出　　处：《中华骨科杂志》2010年第4期363-368,共6页Chinese Journal of Orthopaedics

摘　　要：目的评价全膝关节置换术治疗甲型血友病膝关节病变的疗效、手术特点、假体选择及凝血因子替代治疗的有效性和安全性。方法2003年6月至2009年4月，采用全膝关节置换术治疗甲型血友病膝关节病变患者19例（25膝）；年龄18-54岁，平均33．4岁。Ⅷ因子替代治疗方案为手术当天补充至100％，术后3d内80％以上，术后3d至一周60％以上。术后进行以持续被动活动器（CPM）为主的功能锻炼，锻炼时机为Ⅷ因子输注后6h内。观察比较手术前后膝关节HSS评分、疼痛、活动度及并发症。结果18例（24膝）患者得到随访，随访时间7～54月，平均31个月。术前患者HSS评分为平均（51±14）分（31±64），术后HSS评分为平均（86±9．5）分（62～110）。关节活动度由术前平均55°±26．3°（10°～100°），改善为术后平均82°±18．6°（60°-100°）。屈曲畸形由术前平均19°±13°（0°-45°），改善为术后平均2．7°±3．2°（0°-10°）。所有患者术后1-5d时间内检测的平均Ⅷ因子浓度为74．07％。术后1例发生关节出血，1例发生腓总神经麻痹，1例患者术后17个月因假体感染行翻修术。结论在合理补充凝血因子条件下，全膝关节置换术是治疗血友病膝关节病变的有效方法，可明显改善膝关节症状和活动度。Objective To evaluate the outcome of total knee arthroplasty （TKA） for end-stage hemophilic arthropathy, the effectiveness and safety of factor Ⅷ replacement treatment, and the selection of prothesis. Methods Nineteen patients （25 knees） with type A hemophilie arthropathy underwent TKA from June 2003 to April 2009. The average age at index operation was 33.4 years old （range, 18-54 years）. The level of coagulation factor for replacement treatment was 100% on operation day, 〉80% within 3 days after operation, 〉60% from the third day to the seventh day after operation. Clinical assessment included hospital for special surgery knee score（HSS）, pain symptom, range of rnotion（ROM） and complication. Results Eighteen patients（24 knees） were followed-up, and the average duration was 31 months（range, 7-54 months）. The average preperative HSS score was 51±14 （31-64）, whereas the average postoperative HSS score was 86±9.5 （62-110）. The average preoperative ROM was 55°±26.3°（60°-100°）, whereas the average postoperative ROM was 82°±18.6°（10°-100°）. Flexion eontraeture had improved from 19°±13°（0°-45°） preoperatively to 2.7°± 3.2°（0°-10°） postoperatively. The average serum factor VIII level was 74.07% between the first day and the fifth day after operation. As for postoperative complication, one had a hemarthrosis and one had a paralysis of common peroneal nerve. One patient underwent revision surgery because of infection of femoral component 17 months later. Conclusion TKA is an effective treatment for end-stage hemophilic arthropathy of knee joint, it can provide good outcome and improve the quality of life. Reasonable factor Ⅷ replacement is the basis of successful treatment program.

关 键 词：血友病A 膝关节 因子Ⅷ 关节成形术 置换 膝 

分 类 号：R687.4[医药卫生—骨科学]