全膝关节置换术治疗晚期类风湿性关节炎的早期临床随访研究  

The Short-term Clinical Outcome of Total Knee Arthroplasty in the Treatment of Patients with Rheumatoid Arthritis

作　　者：白国玺[1] 徐小会[1] 段永宏[2] 郭凯[1] 王华溢[1] 朱锦宇[1] 朱庆生[1] 

机构地区：[1]第四军医大学西京医院全军骨科研究所(骨关节外科),陕西西安710032 [2]第四军医大学西京医院急诊中心,陕西西安710032

出　　处：《现代生物医学进展》2014年第35期6926-6930,共5页Progress in Modern Biomedicine

摘　　要：目的：探讨全膝关节置换术（TKA）治疗晚期类风湿性膝关节炎（RA）的早期临床疗效和安全性。方法：回顾性分析2006年-2011年接受TKA治疗的69例（102膝）晚期膝关节RA患者的临床资料,术后及随访时分析患者的影像学资料,末次随访时进行膝关节HSS评分,采用英国矫形外科协会标准评定患者满意度,SF-36健康量表评定患者的生活质量。结果：54例（81膝）患者术后获得2-7年（平均4.3年）随访;6例（7膝）死亡,6例（10膝）失访,3例（4膝）翻修,获得随访患者中1例（1膝）发生下肢深静脉血栓,经介入放置滤网治疗康复后出院,1例（1膝）感染。末次随访时,膝关节活动度（ROM）从术前平均（71.03°±29.51°）提高至（92.26°±10.29°）,膝关节HSS评分从术前平均（47.30±10.06）分提高至（75.93±9.17）分;疼痛发生率和疼痛评分均较术前显著降低;冠状面和矢状面畸形率均较术前显著降低;身体健康（PCS）平均（47.98±6.96）分,心理健康（MCS）平均（41.45±5.67）分,均较术前显著增加,差异均有统计学意义（P〈0.05）。患者的治疗满意率为96.30%,膝关节假体X线片采用膝关节学会的X线评价与计分系统评价未见假体松动。结论：TKA治疗晚期膝关节RA患者2-7年的临床及影像学效果良好,未发现骨溶解、假体松动及严重衬垫磨损等并发症。Objective： To investigate the short-term clinical efficacy and safety of total knee arthroplasty（TKA） in the treatment of patients with rheumatoid arthritis（RA）. Methods： The clinical data of 69 patients（102 knees） with RA who underwent TKA from 2006 to 2011 were retrospectively studied. The postoperative X-ray imaging data were analyzed and the clinical efficacy was assessed at the last follow-up by HSS system, the British Orthopaedic Association patient-satisfaction score and Short Form 36-item Survey（SF-36） were respectively used to evaluate the patients＇ satisfaction and quality of life. for patients＇ health statuses. Results： 54 patients（81 knees）obtained an average follow-up of 4.3 years（from 2 to 7 years）. 6 patients（7 knees） died, 6 patients（10 knees） were lost up, and 3 patient（4 knee） underwent revision surgery. 1 patient（1 knee） had deep venous thrombosis and cured after intervention therapy. At the last follow-up visit, the ROM increased from 71.03°±29.51°（preoperation） to 92.26°±10.29°, the HSS of knee joint increased from（47.30 ±10.06） to（75.93 ±9.17）, the incidence rate of pain, pain score, aberration rate of coronal plane and vertical plane were significantly lower than those preoperation. The PCS was（47.98±6.96）, MCS was 41.45±5.67, which were both predominantly higher than those preoperation（P〈0.05）. The satisfaction rate of patients was 96.30%. No prosthetic loosening was found according to The Knee Society total knee arthroplasty roentgen graphic evaluation and scoring system. Conclusion： The study showed good 2-7-year clinical and radiological efficacy of TKA in the treatment of patients with RA. No serious complications such as osteolysis, loosening and severe friction was found during the treatment.

关 键 词：晚期类风湿性关节炎 全膝关节置换术 髌骨置换 治疗效果 安全性 

分 类 号：R684.3[医药卫生—骨科学]