全膝关节表面置换对膝骨性关节炎Ⅳ期患者膝关节功能恢复和肾功能的影响

Effect of Total Knee Arthroplasty on Knee Joint Functional Recovery and Renal Function of Patients with Knee Osteoarthritis

目的探究并分析全膝关节表面置换对膝骨性关节炎Ⅳ期患者膝关节功能恢复和肾功能的影响。方法选取2012年12月至2014年12月瓦房店第三医院收治的行全膝关节表面置换治疗的膝骨性关节炎Ⅳ期患者58例,按照随机数字表法分为观察组(30例)和对照组(28例)。观察组患者采取人工全膝关节表面置换术,对照组采取关节清扫术,对患者进行1个月的随访,观察并记录两组膝关节功能恢复情况以及肾功能指标的变化。结果观察组优良率显著高于对照组[90.0%(27/30)比64.3%(18/28)],差异有统计学意义(P<0.05)。两组患者血清肌酐水平在组间、不同时点间及组间·不同时点间的交互效应比较差异无统计学意义(P>0.05)。对照组术前、术后1 d、术后7 d、术后30 d的尿微量白蛋白/尿肌酐浓度分别为(52±4)mg/g、(53±4)mg/g、(53±4)mg/g、(50±4)mg/g,术后先升高,7 d后开始降低,但变化不大;观察组分别为(52±4)mg/g、(54±4)mg/g、(51±5)mg/g、(41±3)mg/g,于术后1 d升到最高,随后开始不断降低,两组在组间、不同时点间及组间、不同时点间的交互效应比较差异有统计学意义(P<0.05)。对照组术前、术后1 d、术后7 d、术后30 d的胱抑素C水平分别为(0.88±0.13)mg/L、(0.87±0.12)mg/L、(0.88±0.17)mg/L、(0.88±0.14)mg/L,于术后1 d有所降低,随后恢复;观察组分别为(0.88±0.12)mg/L、(0.87±0.16)mg/L、(0.85±0.12)mg/L、(0.82±0.03)mg/L,于术后1 d开始不断降低,并于术后30 d达到最低值,两组在组间、不同时点间及组间、不同时点间的交互效应比较差异有统计学意义(P<0.05)。结论全膝关节表面置换能有效改善关节炎患者膝关节功能,疗效显著,但术后可能发生肾功能不全,需引起重视。

Objective To explore and analyze the effect of total knee replacement therapy on the knee func- tion recovery and renal function of patients with knee osteoarthrltis. Methods Total of 58 patients with stage Ⅳ knee osteoarthritis treated by total knee replacement therapy in Wafangdian Third Hospital from Dec. 2012 to Dec. 2014 were included in the study and divided into observation group （30 cases） and control group （28 cases ） according to random number table method. The observation group was treated by artificial total knee replacement therapy, while the control group was treated by joint dissection, and all patients were followed up for one month to observe and record the changes of the knee function and renal function. Results Excellent rate of the observation group was significantly higher than the control group [ 90. 0% （ 27/30 ） vs 64. 3% （ 18/28 ） ], the difference_ was statistically significant（p 〈0. 05 ）. The Serum creatinine concentration were not statistically significantly different between groups, time points and groups time points interaction（ P 〉 0.05 ）. The urine micro albumin/urine creati- nine concentrations of the aontrol group before surgery and 1 d, 7 d, 30 d postoperative were （ 52 ± 4 ） mg/g, （53 ± 4） mg/g, （53 ± 4 ） rag/g, （50 ± 4 ） mg/g respectively, which increased first after surgery and decreased after 7 d, while the difference was not significant; of the observation group were ： （52 ± 4 ） mg/g, （54 ± 4） mg/g, （51 ±5） mg/g, （41 ±3） mg/g,which increased to the top at 1 d postoperative,then started to decrease. The difference were statistically significant between groups, time points and groups time points interaction （P 〈 0. 05 ）. The cystatin C concentrations of the control group before surgery, 1 d,7 d,30 d postoperative were （0. 88 ± 0. 13 ） rag/L, （0.87 ±0. 12） mg/L, （0. 88 ±0. 17） mg,/L, （0. 88 ±0. 14） mg/L respectively,which decreased a little at 1 d postoperativ, then recovered; of the observation group were （0. 88 ± 0. 12 ） mg/L, （0. 87 ± 0. 16 ） mg/L, （0. 85 ±0. 12） rag/L, （0. 82 ±0. 03） mg/L,which decreased from 1 d postoperative,and went to the lowest at 30 d postoperative, the difference were statistically significant between groups, time points and groups time points interaction（P 〈 0. 05 ）. Conclusion The total knee replacement can significantly improve the knee function of patients with osteoarthritis, but may lead to postoperative renal dysfunction, calling for due attention.