人工全膝关节置换术治疗晚期类风湿性关节炎的疗效研究

Clinical analysis of total knee arthroplasty in patients with late rheumatoid arthritis

目的：探讨人工全膝关节置换术（total knee arthroplasty,TKA）治疗晚期膝关节类风湿性关节炎的手术方法及临床疗效。方法：回顾性分析2006年7月至2014年11月,采用全膝关节置换术治疗晚期膝关节类风湿性关节炎患者36例（45膝）。其中男24例,女12例。年龄58-79岁,平均72岁。临床症状主要表现为患膝疼痛,屈曲挛缩畸形及功能受限。术后随访膝关节（HSS评分）及放射X片影像学改变。结果：所有病人术后平均随访43个月,无1例出现假体周围感染、深静脉血栓形成等并发症。5例术后出现腓总神经麻痹,经过营养神经等保守治疗,术后半年恢复。膝关节HSS评分由术前（51.75±4.14）分上升至术后（85.75±2.47）分,与术前HSS评分比较,P〈0.01,差异有统计学意义,其中优31膝,良9膝,优良率达89%。膝关节假体X线片影像学随访未见假体松动。结论：人工全膝关节置换术中通过精确的截骨纠正下肢力线以及合理的软组织松解治疗晚期类风湿性关节炎可获得满意的临床疗效。

Objective： To explore the clinical effect and techniques of total knee arthroplasty（TKA） on the patients with late knee rheumatoid arthritis（RA）. Methods： From july 2006 to November 2014, TKA waw performed in 36 patients with 45 knees suffered from late RA, including male 24 knees and female 12 knees, with an average age of 72 years（58 - 79 years）. All patients experienced severe pain and knee flexion contracture.The patients were all followed up and evaluated with HSS score and X radiographic examination. Results： The average period of follow-up was 43 months. The mean HSS score was improved from preoperative 51.75 ±4.14 points to postoperative 85.75 ± 2.47 points, with statistically significant difference（P 〈0.01）. According to HSS,31 knees were rated excellent, 9 good, and the choiceness rate was 89%. There were no complications such as infection and deep vein thrombus, knee flexion contracture was improved and the prosthesis position was good in following up X radiographic examination in all patients with RA. Conclucsions： TKA is an effective method for patients with RA and the satisfactory clinical effects of TKA are produced through accurate amputation and proper balancing of the soft tissue during the surgery.