全膝关节置换治疗类风湿性膝关节炎的早期急性并发症  

Early acute complications after total knee arthroplasty in patients with rheumatoid arthritis

作　　者：沈瑞 胡川 王翠[1] 饶慧丽 丁涛 孙康[1] 田少奇[1] Shen Rui;Hu Chuan;Wang Cui;Rao Huili;Ding Tao;Sun Kang;Tian Shaoqi(Department of Orthopedics,the Affiliated Hospital of Qingdao University,Qingdao 266000,Shandong Province,China;Department of Nursing,Sir Run Run Shaw Hospital Affiliated to Zhejiang University,Hangzhou 310016,Zhejiang Province,China;Department of Joint Surgery,Affiliated Hospital of Weifang Medical University,Weifang 261031,Shandong Province,China)

机构地区：[1]青岛大学附属医院骨科,山东省青岛市266000 [2]浙江大学医学院附属邵逸夫医院护理部,浙江省杭州市310016 [3]潍坊医学院附属医院关节外科,山东省潍坊市261031

出　　处：《中国组织工程研究》2020年第18期2836-2841,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金项目(青年科学基金项目)(81702172)，项目负责人：田少奇~~

摘　　要：背景:类风湿性关节炎患者行全膝关节置换的数量不断增加,但是目前尚无研究报道类风湿性关节炎患者行全膝关节置换后早期并发症的发生情况及相关危险因素。目的:探讨类风湿性关节炎患者行初次全膝关节置换后早期急性并发症的发生情况及危险因素。方法:回顾性分析2013年9月至2019年5月于青岛大学附属医院因类风湿性关节炎行初次全膝关节置换的300例患者(337膝)的资料,其中男62例,女238例,平均(65.61±8.40)岁。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。收集并记录患者基本信息、并存疾病、术前检查、手术信息、住院其他信息及随访资料,分析患者并发症发生的相关危险因素,并利用受试者工作特征曲线计算相关资料对类风湿性关节炎患者术后30 d内并发症的预测价值。结果与结论:①共9例患者在术后30 d内出现急性并发症,发生率为3.33%;②多因素Logistic回归分析结果显示,并发症组患者手术时间、年龄、病程和术前合并脑血管疾病是类风湿性关节炎患者全膝关节置换后30 d内并发症发生的独立危险因素;③并发症组患者手术时间大于无并发症组(OR=1.023,95%CI:1.001-1.045,P=0.037),年龄大于无并发症组(OR=1.163,95%CI:1.025-1.319,P=0.019),病程大于无并发症组(OR=1.110,95%CI:1.031-1.195,P=0.006),术前合并脑血管疾病比例大于无并发症组(OR=31.736,95%CI:4.053-248.517,P=0.001);④受试者工作特征曲线表明,年龄、病程及手术时间预测类风湿性关节炎患者全膝关节置换后30 d内并发症的曲线下面积分别为0.693,0.865,0.685。BACKGROUND:The number of rheumatoid arthritis patients undergoing total knee arthroplasty is increasing,but the postoperative early complications and related risk factors have not been reported.OBJECTIVE:To investigate the early acute complications and the risk factors after primary total knee arthroplasty in patients with rheumatoid arthritis.METHODS:Data of 300 patients(337 knees)with rheumatoid arthritis who received primary total knee arthroplasty at Affiliated Hospital of Qingdao University from September 2013 to May 2019 were retrospectively analyzed.There were 62 males and 238 females,with an age of(65.61±8.40)years old.All patients signed the informed consent,and the study was approved by the ethics committee of the hospital.The baseline data,comorbidities,preoperative examination,surgical data,other data of hospitalization and follow-up data were recorded.The risk factors of complications were analyzed.The receiver operating characteristic curve was used to assess the predictive value of risk factors for postoperative complications within 30 days after surgery in rheumatoid arthritis patients.RESULTS AND CONCLUSION:(1)Nine cases(3.33%)affected acute complications within 30 days after surgery.(2)Multivariate Logistic regression analysis showed that operation time,age,duration of disease and preoperative cerebrovascular disease were independent risk factors for postoperative complications within 30 days after total knee arthroplasty in rheumatoid arthritis patients.(3)Compared with the non-complication group,in the complication group,the operation time was longer(OR=1.023,95%CI:1.001-1.045,P=0.037),the age was increased(OR=1.163,95%CI:1.025-1.319,P=0.019),the duration of disease was longer(OR=1.110,95%CI:1.031-1.195,P=0.006),and the proportion of preoperative cerebrovascular disease was increased(OR=31.736,95%CI:4.053-248.517,P=0.001).(4)The receiver operating characteristic curve to predict the complications in patients with rheumatoid arthritis within 30 days after total knee arthroplasty showed that th

关 键 词：类风湿性关节炎 全膝关节置换 术后并发症 危险因素 病程 手术时间 脑血管疾病 国家自然科学基金 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]