手术治疗腰椎退行性疾病合并膝骨关节炎的临床分析

Surgical management for lumbar degenerative disease combined with knee osteoarthritis

背景：腰椎退行性疾病与原发性膝骨关节炎是两类常见的退行性疾病，同时具备这两类病变手术指征的患者较少，目前针对这类患者的研究甚少。 目的：探讨先后行腰椎手术及单侧/双侧全膝关节置换术（TKA）患者的临床特点。 方法：2006年5月至2013年1月，因腰椎退行性疾病及膝骨关节炎先后行腰椎手术及TKA患者10例，年龄58~72岁，平均（63.7±5.2）岁；女9例，男1例。术后3个月、6个月、1年及末次随访时行腰椎及膝关节正侧位X线检查。分析本组患者人口统计学、临床表现、影像学特征、HSS评分、手术情况、预后、并发症等临床资料，并对临床表现与影像学参数之间进行相关性分析。 结果：随访时间6~85个月，平均（45.5±27.2）个月。10例患者中，8例先行腰椎手术，2例先行TKA；8例分2次住院完成手术治疗，2例通过1次住院完成手术治疗；2例腰椎退变严重侧与原发性膝骨关节炎病变严重侧的偏向一致，8例偏向相反；5例合并退行性腰椎侧凸，其中3例腰椎侧凸的偏向与膝骨关节炎严重侧的偏向一致，另2例偏向相反；术前膝骨关节炎严重侧HSS评分与矢状面腰椎序列不存在相关性（P=0.527），术前膝骨关节炎严重侧伸直受限角度与矢状面腰椎序列亦不存在相关性（P=0.460）。随访期间未发现严重并发症，患者对于手术效果满意。 结论：对于腰椎退行性疾病合并膝骨关节炎的患者可先后行腰椎手术及TKA治疗，但应根据患者的具体情况合理制定手术方案，做好医患沟通，进行恰当的疗效预估。

Background：Both lumbar degenerative diseases and knee osteoarthritis are common types of degenerative diseases. Howev-er, for the patients with surgical indications of both lesions, few studies have been reported. Objective：The aim of the study is to explore the clinical features of patients undergoing both lumbar surgery and total knee arthroplasty （TKA）. Methods：From May 2006 to January 2013, 10 patients underwent both lumbar surgery and TKA in our hospital. There were 9 females and 1 male with an average age of （63.7 ＆#177; 5.2） years （range 58-72 years）. Lumbar and knee radiographic evalua-tions were performed before surgery and at 3, 6, and 12 months after surgery and the last follow-up. Clinical data, including de-mographic information, clinical manifestations, imaging characteristics, preoperative HSS score, prognosis and complications were retrospectively analyzed. The correlation between clinical manifestation and imaging characteristics was evaluated. Results：The average follow-up period was （45.5＆#177;27.2） months （range 6-85 months）. Lumbar surgery was performed first in 8 patients, and TKA was performed first in 2 patients. Eight patients underwent the two operations through two visits to hos-pital. In 8 cases, the more-affected side of lumbar degenerative disease was inconsistent with that of knee osteoarthritis. There were 5 patients accompanied with degenerative lumbar scoliosis, 3 of whom had the same bias of scoliosis and knee osteoarthritis. There was no significant correlation between preoperative HSS score and lumbar sagittal sequence （P=0.527）. Neither was correlation between the angle of extension lag of affected knee and lumbar sagittal sequence （P=0.460）. No seri-ous complications were found. All patients were satisfied with the therapeutic effect. Conclusions：For patients with surgical indications for both degenerative lumbar diseases and knee osteoarthritis, it is impor-tant for surgeons to make a reasonable surgical plan based on the specific situation of the patients. Good doctor-patient com-munication and proper estimation of curative effect will play an important role during treatment.