Charcot关节病全膝关节置换手术疗效及文献分析

The effects of total knee arthroplasty in Charot joint and literature review

目的探讨膝关节Charcot关节病行全膝关节置换术(TKA)手术疗效及注意事项。方法对本中心5例Charcot关节病患者8个膝关节行TKA的手术疗效进行回顾分析。5例患者,男2例,女3例,手术平均年龄60岁(54～68岁)。2例行单侧TKA,3例行双侧分次TKA。采用KSS评分标准对手术疗效进行评价。另外,计算机检索Pubmed、Medline、Embase、万方数据库、中国生物医学文献数据库、中文科技期刊数据库近十年(2000～2011)公开发表的文献,同时配合手工检索已发表的骨科论文,并查阅相关文章所附的参考文献。对所纳入的文献研究进行分析讨论。结果随访时间平均12个月(2～20个月),8个膝关节TKA术后均无感染及松动发生。KSS评分由术前平均39.00分(13～55分)增加到术后平均93.25分(91～96分),患者对功能及关节的稳定性满意。共有9篇文献描述了Charcot关节病TKA的疗效、假体选择、外科技术、并发症及术后处理。结论本中心膝关节Charcot关节病行TKA的近期随访结果满意,结合文献研究,选择适当的假体、良好的手术操作和术后康复,Charcot关节病患者可以通过TKA获得良好的中期结果。

Objective To discuss the results of total knee arthroplasty （TKA） for Charcot joint and surgical announcements. Methods Five patients （two males and three females; eight knees） with Charcot joint of knee were treated in our hospital. At the time of sm＇gery, the mean age was 60 years （range, 54 - 68 years）. Two had unilateral TKA and three had bilateral TKA..All the patients were evaluated by KSS score system. Meanwhile, Pubmed, Medline, Embase, WanFang database, CBMdisc, and Chinese Science ＆ Technology Journal Database were searched, and the references of the included studies were searched at the same time. Then the inclusion literatures were discussed and analyzed. Results The mean follow-up time was 12 months （range, two-20months）. No infection or prosthetic loosening was developed after TKA. The average KSS score increased from 39. 00 points to 93.25 points. All five patients were very satisfied with the clinical results at the last follow-up. Total nine studies described the efficacy of TKA, prosthesis selection, surgical techniques, complications and postoperative management in Charcot joint. Conclusions According to the clinical results in our center and the analysis of literature, patients of Charcot joint can get good in medium-term by TKA with proper prosthesis selection, good surgical techniques and postoperative rehabilitation.