人工膝关节置换的临床特点及术后并发症分析

Analysis of the special clinical features of total knee arthroplasty and its postoperative complication

目的探讨人工膝关节置换的临床特点及术后并发症出现的类型、原因及处理方法.方法本组58例65膝,骨性关节炎45例,类风湿性关节炎8例,创伤性关节炎5例.单膝关节置换58膝,双膝关节置换7膝.结果术后随访1～8年,疼痛完全缓解54膝,行长路后轻度疼痛9膝,中、重度疼痛2膝;切口感染2膝;关节感染1膝;关节僵直3膝;关节失稳1膝;假体松动1膝;下肢深静脉血栓形成2例.优良率为87.69%.结论术前关节功能的评估、假体选择,术中切骨量、软组织平衡等的准确把握,是预防人工膝关节置换术后并发症发生的重要手段.术后出现的并发症以保守治疗为主,谨慎采用手术治疗,如关节镜下清理术、翻修术等.

Objective To explore the special clinical features of total knee arthroplasty （TKA） and the type,cause and treatment of the postoperative complication.Methyls 65 cases of TKA were performed for 58 patients including 45 osteoarthritis, 8 rheumatoid arthritis and 5 traumatic arthritis. There were 58 unilateral total knee replacements（TKR） and 7 bilateral TKR.Results All postoperative cases were followed up for i to 8 years. There were 54 knees with pain full disappearance, 9 light pain, 2 moderate and severe pain after a long-distance walk; 2 infection of incision; 1 infection of joint; 3 stiffness of joint; 1 unstable state of joint; 1 prosthesis loosen and 2 thrombosis of deep vein of lower limb postoperative. The excellent and good rates is 87.69% .Conclusion Not only assessment of function of joint and selection of prothesis preoperative but also correct excision of bone amounts,and the balance of soft tissue intraoperative are of most importance to prevent postoperative complications of TKR. It is suggested the complications of TKR should be dealed with conservative treatment rather than surgery such as arthscopic debridement and revision etc.