初次全膝关节置换术后并发症及翻修手术的原因分析

Postoperative complications and revision surgery following primary total knee arthroplasty after midterm follow-up

目的 探讨初次全膝关节置换术后30 d内相关并发症发生情况及翻修手术的相关因素.方法 收集2001年1月至2012年12月在北京协和医院骨科进行初次全膝关节置换术患者的临床资料,假体均为固定平台假体,采用骨水泥固定,排除翻修病例及血友病关节炎患者.共有1 920例患者（2 779例次全膝关节置换手术）纳入研究,男性323例,女性1 607例;年龄25～86岁,平均（66±9）岁.骨关节炎1 720例（89.58％）,类风湿关节炎168例（8.75％）,强直性脊柱炎12例（0.63％）,继发骨关节炎20例（1.04％）.随访患者术后30 d内发生的主要系统并发症、局部并发症及发生的翻修手术及相关因素.结果 随访截至2013年12月,共有1 854例患者（2 693个关节）获得随访,失访率为3.44％.术后平均随访67个月,死亡3例.41例（2.21％）患者出现系统并发症,其中最常见的为呼吸系统并发症（0.49％,9/1 854）及心血管并发症（0.38％,7/1 854）.术后经超声证实的症状性深静脉血栓形成发生率为3.02％ （56/1 854）,其中7例发生肺栓塞.术后发生局部并发症24例（1.29％）,包括伤口愈合不良、伤口感染、神经损伤.59个关节接受翻修手术治疗,常见原因包括感染后松动（1.19％,32/2 693）和术后关节僵硬（0.37％,10/2693）.结论 初次全膝关节置换术后30 d内最常见系统并发症为呼吸系统及心血管系统并发症.感染后松动是术后翻修最常见的原因.

Objective To determine the postoperative complications of primary total knee arthroplasty （TKA） within 30 postoperative days,and the different causes for revision surgery during follow-up.Methods Between January 2001 and December 2012,a total of 1 920 patients underwent 2 779 primary TKA with fixed bearing platform in Peking Union Medical College Hospital,with 323 for male and 1 607 for female.The revision surgery at index time and the hemophiliac arthropathy were excluded for this study.The average age was （66 ± 9）years（from 25 to 86 years）.Osteoarthritis accounted for 1 720 cases（89.58%）,rheumatoid arthritis for 168 cases （8.75 %）,ankylosing spondylitis for 12 cases （0.63%）,secondary arthritis for 20 cases （1.04%）.The postoperative complications with 30 postoperative days and revision surgery during follow-up were recorded.Results Follow-up was concluded at December 2013.Totally,1 854 patients （2 693 knees） were successfully followed-up.Forty-one patients experienced systemic complication within 30 postoperative days,with the rate of 2.21%.The most common reasons of systemic complication were the respiratory complication and cardiovascular complication in origin,with the rate of 0.49% （9/1 854） and 0.38% （7/1 854） respectively.The average rate of deep venous thrombosis in this group was 3.02% （56/1 854）.The local complication rate within 30 days was 1.29% in this group.Totally 59 knees experienced the revision surgeries during average 67 months follow-up.The most common causes for revision surgery in relative values were septic loosening,with the rate of 1.19% （32 in 2 693 knees）,followed by postoperative stiffness,with the rate of 0.37% （10 in 2 693 knees）.Conclusions The most cormon reasons of systemic complication with 30 postoperative days after primary TKA procedure are the respiratory complication and cardiovascular complication in origin.The most common reason for revision surgery during mid-term follow-up for primary TKA is septic loosening.