多关节置换治疗晚期下肢关节疾患

EFFECTIVENESS OF MULTIPLE JOINT ARTHROPLASTY IN TREATING LOWER LIMB JOINT DISEASE

目的探讨下肢多关节置换治疗晚期关节疾患的有效性。方法回顾分析2000年1月-2007年12月行下肢3个或以上关节置换的5例患者临床资料。男3例,女2例,年龄27～59岁,平均41.8岁。强直性脊柱炎2例,类风湿性关节炎3例;均为下肢髋、膝关节受累。4例完全丧失行走功能,1例患者扶拐可自行活动。髋关节功能根据Harris评分标准为(24±24)分,膝关节功能根据美国特种外科医院(HSS)评分标准为(28±15)分。一期多关节置换2例,二期置换2例,三期置换1例。结果术后患者切口均Ⅰ期愈合。1例术后发生髋关节脱位,手法复位后给予下肢制动皮牵引3周,无关节再脱位发生。2例术后2 d内出现贫血,给予积极扩容补充红细胞后改善。5例患者均获随访,随访时间46～140个月,平均75个月。患者基本能正常行走及上、下楼梯。髋、膝关节稳定性好,无关节感染及松动发生。末次随访时,髋关节功能根据Harris评分为(88±6)分,与术前比较差异有统计学意义(t=8.16,P=0.00);膝关节功能根据HSS评分为(86±6)分,与术前比较差异有统计学意义(t=13.96,P=0.00)。结论下肢多关节置换是治疗晚期关节疾患的有效方法,可显著提高患者生活质量。

Objective To explore the effectiveness of multiple joint arthroplasty in treating lower limb joint disease.Methods Between January 2000 and December 2007,5 patients with lower limb joint disease（three or more joints were involved） were treated with total hip and knee arthroplasty.There were 3 males and 2 females,aged from 27 to 59 years（mean,41.8 years）.Two patients had ankylosing spondylitis and 3 had rheumatoid arthritis,whose hip and knee joints were involved.Four patients lost the ability of walking preoperatively,1 patient could only walk with crutch.The Harris score was 24 ± 24 and the Hospital for Special Surgery（HSS） score was 28 ± 15.All patients underwent multiple joint arthroplasty simultaneously（2 cases） or multiple-stage（3 cases）.Results Wounds healed by first intention in all patients.In 1 patient who had dislocation of the hip after operation,manipulative reduction and immobilization with skin traction were given for 3 weeks,and no dislocation occurred;in 2 patients who had early sign of anemia,blood transfusion was given.All patients were followed up 46-140 months with an average of 75 months.The patients could walk normally,and had no difficulty in upstairs and downstairs.The stability of the hip and knee was good,and no joint infection or loosening occurred.The Harris score was 88 ± 6 at last follow-up,showing significant difference when compared with the preoperative score（t=8.16,P=0.00）;the HSS score was 86 ± 6,showing significant difference when compared with the preoperative score（t=13.96,P=0.00）.Conclusion Multiple joint arthroplasty is an effective treatment method in patients with lower limb joint disease,which can significantly improve life quality of patients.