人工全膝关节置换术治疗膝关节类风湿性关节炎中短期疗效随访

Mid-term effects of total knee arthroplasty in patients with rheumatoid arthritis

目的：为了观察人工全膝关节置换术（ TKA）治疗膝关节类风湿性关节炎（ RA）的中短期治疗效果。方法随访2007至2011年间行TKA治疗的38例（58膝）膝关节RA患者。采用HSS评分、KSS评分、WOMAC评分、VAS视觉疼痛评分对术前及术后患者的膝关节功能进行评价、同时对术后随访影像学资料进行评价；采用SF-36量表对患者健康状况进行评价。结果所有患者均未出现感染且获得平均3.3年（2～6年）随访，膝关节功能均明显改善，患者膝关节HSS评分由术前45.92±13.49分提高到术后88.19±5.98分，两者采用配对t 检验比较差异有统计学意义（ P ＝0.00），其中优21膝，良34膝，优良率94.83％。膝关节屈曲畸形明显改善，膝关节活动度（ROM）由术前71.81°±32.58°提高到术后100.98°±13.99°，两者比较差异有统计学意义（ P＝0.00）。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。 SF-36评分中PCS由术前的26.27±3.91分提高到术后48.09±6.65分，两者比较差异有统计学意义（ P＝0.00）；MCS由术前的41.59±5.61分提高到51.83±5.44分，两者比较差异有统计学意义（ P＝0.00）。结论 TKA是治疗膝关节RA的有效方法，可提高患者生活质量。

Objective To observe the Shorterm effects of the total knee arthroplasty （ TKA） in the patients with rheumatoid arthritis （ RA） .Methods A retrospective analysis was performed in 38 patients （58 knees） with RA, who had underwent TKA in 2007 to 2011.The clinical results were evaluated by＆amp;nbsp;HSS, KSS, WOMAC, and VAS visual scoring systems .The health status of the patients was evaluated by the Short Form 36-item Survey （SF-36）.Results The average follow-up duration in this study was 3.3 years （range, 2-6 years）.All the functions of the knee joint were improved after TKA .The average score of HSS was improved from the preoperative 45.92 ±13.49 to the 88.19 ±5.98 at the follow-up examination （P=0.00）;21 cases were rated as excellent and 34 cases were rated as good （the excellent or good results rate was 94.83%） .The severe flexion deformities of the involving knees had been corrected completely.The average ranges of motion improved from the preoperative 71.81°±32.58°to the 100.98 ± 13.99 at the final follow-up.The extension range of the knee increased （ P =0.00 ）.No loosening happened according to roentgen graphic evaluation and scoring system of the Knee Society .The mean value of the SF-36 scores showed an average improvement from 26.27 ±3.91 preoperatively to 48.09 ±6.65 at the final follow-up （ P =0.00 ） . The MCS showed an average improvement from 41.59 ±5.61 preoperatively to 51.83 ±5.44 at the final follow-up （ P =0.00 ） .Conclusion TKA is an effective method for treating the patients with RA , which can improve the patients＆#39;life quality.