血友病性关节炎患者的全膝关节置换  

Total knee arthroplasty in patients with hemophilic arthritis

作　　者：侯波[1] 王毅[2] 沈宇辉[2] 冯建民[2] 刘志宏[2] 何川[2] 

机构地区：[1]上海市伤骨科研究所,上海市200025 [2]上海交通大学附属瑞金医院骨科,上海市200025

出　　处：《中国组织工程研究》2012年第48期8958-8962,共5页Chinese Journal of Tissue Engineering Research

基　　金：上海市科学自然基金面上项目(10ZR1427800);上海交通大学医工(理)交叉研究基金项目(YG2011MS10)~~

摘　　要：背景:血友病性膝关节炎患者行全膝关节置换的疗效与凝血因子替代治疗方案以及手术技术有直接关系。目的:总结12例血友病性关节炎患者行全膝关节置换的效果,对患者围手术期的全程凝血因子Ⅷ监测和替代治疗方案进行阐述。方法:以瑞金医院凝血因子替代方案为标准,结合患者实际凝血因子水平,搭配有经验的医生,对12例(17膝)男性血友病关节炎患者实施全膝关节置换,采用Cleveland膝关节评分和膝关节协会评分(KSS评分)进行功能评估。结果与结论:根据Cleveland膝关节评分,优8膝,一般3膝,差3膝,1例大腿截肢患者和2例关节融合患者不参与该评分。根据KSS评分,膝关节评分从置换前(23.6±9.0)分增加到末次随访时的(86.7±12.1)分,平均膝关节功能评分从置换前(25.2±28.4)分增加到末次随访时的(65.7±39.8)分。结果可见对于血友病膝关节病患者,围手术期应用合理的凝血因子替代方案,关节功能得到了良好的恢复,但是风险较大,需要谨慎进行。BACKGROUND：The effect of total knee arthroplasty for the treatment of hemophilic arthritis is directly related to the coagulation factor replacement treatment programs and surgical techniques.OBJECTIVE：To summarize the rehabilitation outcome of 12 hemophilic arthritis patients treated with total knee arthroplasty,and to describe the coagulation factor Ⅷ monitoring and alternative treatment program in perioperative period.METHODS：Take the coagulation factor replacement therapy scheme by Ruijin Hospital as a standard,combining with the actual factor level and experienced surgeon,we operated total knee arthroplasty for the 12 male patients（17 knees） with hemophilic arthritis.Function was assessed using the Cleveland score and the Knee Society Rating Scale.RESULTS AND CONCLUSION：Results were excellent in 8 knees,fair in 3 knees and poor in 3 knees according to the Cleveland score,1 thigh amputees and 2 patients who suffered from joint fusion surgery were not involved in this score.According to KSS score,average knee score increased from（23.6±9.0） preoperatively to（86.7±12.1） postoperatively,average knee function score increased from（25.2±28.4） preoperatively to（65.7±39.8） postoperatively.For the patients with hemophilic arthritis,reasonable alternative treatment program can promote the recovery of joint function,but it has bigger risk,so caution is necessary.

关 键 词：血友病 关节成形术 膝关节 凝血因子 全膝关节置换 

分 类 号：R318[医药卫生—生物医学工程]