严重痛风性膝关节炎的膝关节表面置换  

Total knee replacement for severe gouty knee arthritis

作　　者：刘康[1] 郭国栋[1] 赵建宁[1] 

机构地区：[1]南京大学医学院临床学院,解放军南京军区南京总医院骨科,江苏省南京市210002

出　　处：《中国组织工程研究》2016年第4期486-491,共6页Chinese Journal of Tissue Engineering Research

基　　金：江苏省临床医学科技专项基金(BL2012002);南京市科研基金(201402007)~~

摘　　要：背景:因严重痛风性关节炎需行人工膝关节表面置换的患者日益增多,且患者的年龄层次呈现年轻化趋势。但其临床疗效仍然存在较大争议,见诸文字的系统性回顾分析几乎缺如。目的:通过疼痛、功能、生活质量及置换并发症等几个方面内容的评估回顾性分析严重痛风性关节炎患者行人工膝关节表面置换的临床疗效。方法:2006年1月至2015年1月解放军南京军区南京总医院骨科关节组采用人工膝关节表面置换治疗严重痛风性膝关节炎患者17例20膝,均采用不保留后交叉韧带的膝关节表面置换,髌骨均不予以置换,假体采用后稳定型进口假体。置换后均获得随访,置换前、置换后及末次随访时测定膝关节美国纽约特种外科医院评分、膝关节活动度、疼痛目测类比评分及SF-36量表评分。结果与结论:患者随访时间1-9年。所有患者置换术中及置换后无严重并发症发生。置换后及末次随访时膝关节美国纽约特种外科医院评分、膝关节活动度、疼痛目测类比评分及生理及心理健康SF-36量表评分均较治疗前有明显提高(P<0.001)。所有患者置换后X射线片均示假体位置良好,下肢力线满意,无透亮线及任何松动迹象。提示膝关节表面置换作为严重痛风性关节炎的最终修复手段,其短期临床疗效显著,但要获得较好的长期效果,系统的抗尿酸治疗,并发症的防治,疼痛的控制,功能锻炼以及身心健康的调节等多方面的努力是最终保证。BACKGROUND： The number of patients undergoing total knee replacement due to severe gouty arthritis is increasing rapidly in recent years, and the ages of patients also present younger and younger. However, its clinical efficacy remains controversial, and it is lack of retrospective systematic analysis. OBJECTIVE： To assess the clinical efficacy of total knee replacement for severe gouty knee arthritis from several aspects, such as pain, function, quality of life and complications. METHODS： From January 2006 to January 2015, 17 patients（20 knees） with severe knee gouty arthritis receivedtotal knee replacement in Department of Orthopedics of Nanjing General Hospital of Nanjing Military Region of Chinese PLA. They underwent knee joint surface replacement with posterior cruciate ligament, and patella was not replaced. Posterior stabilized prosthesis was used. All patients were successfully followed up postoperatively. The Hospital for Special Surgery Knee Score, range of motion of the knee, Visual Analogue Scale score and SF-36 scale scores were determined before and after replacement and during final follow-up. RESULTS AND CONCLUSION： Patients were followed up for 1-9 years. No serious complications occurred during and after replacement. The Hospital for Special Surgery Knee Score, range of motion of the knee, Visual Analogue Scale score and SF-36 scale scores were significantly higher after replacement and during final follow-up than those before replacement（P〈 0.001）. X-ray films showed good prosthesis position, satisfactory limb alignment without radiolucent lines or loosing. These findings verified that total knee replacement was considered as the final way to treat the severe gouty knee arthritis; its short-term clinical effect is significant, but systematic anti-uric acid, prevention and treatment of complications, pain control, function exercising, and healthy mood maintenance were needed to get a better long-term clinical efficacy.

关 键 词：关节成形术 置换 膝 假体植入 关节炎 痛风性 随访研究 组织工程 骨科植入物 人工假体 痛风性关节炎 膝关节表面置换 

分 类 号：R318[医药卫生—生物医学工程]