固定平台后稳定型假体在老年类风湿性关节炎全膝关节置换中的应用

Application of stable prosthesis in total knee replacement in elderly patients with rheumatoid arthritis

目的 评价人工全膝关节置换中使用固定平台后稳定型假体治疗老年类风湿性关节炎（RA）的临床效果.方法 回顾性分析2009年1月至2013年1月收治的老年RA患者53例（62膝）施行固定平台后稳定型假体治疗的临床资料.结果 53例患者术后获得24.0～43.0个月随访,平均（25.0±2.1）个月;末次随访时膝关节活动度较术前明显改善[（116.0±6.0）°与（46.0±7.0）°,差异有统计学意义（t=35.323,P＜0.01）].末次随访时美国特种外科医院膝关节评分（HSS）较术前明显改善[（85.3±7.6）分与（50.2±11.3）分,差异有统计学意义（t=4.002,P＜0.05）].末次随访时优35例（66.0％）,良11例（20.8％）,可7例（13.2％）.术后所有患者在关节疼痛、肿胀、功能障碍、畸形等方面获得明显改善.结论 固定平台后稳定型假体手术方法简单、疗效确切,术后并发症少,对于不需要高屈曲活动的老年RA患者是一种更佳的术式选择.

Objective To evaluate the short-middle term clinical effects of the fixed platform stabilized prosthesis in the treatment of the elderly patients with rheumatoid arthritis（RA）.Methods The clinical data of 53 cases elderly RA patients who were admitted to the People＆#39;s Hospital of Liuzhou from January 2009 to January 2013 and were treated with fixed platform and stable prosthesis in 62 knees were retrospective analyzed.Results Fifty-three patients were followed up for 24.0-43.0 months with average （25 ± 2.1）months.At the last follow-up,the degree of knee motion was improved significantly compared with the preoperative（（116.0±6.0） ＆#176; vs.（46.0±7.0）＆#176;）,the difference was significant（t=35.323,P〈0.01）.The HSS score was significantly improved compared with the preoperative （（85.3±7.6） points vs.（50.2±11.3）points）,the difference was significant （t=4.002,P〈0.05）.At the last follow-up,35 cases （66.0%） of excellent,11 cases （20.8%） of good,and 7 cases （13.2%） of normal.After the operation,all patients obtained obvious improvement in joint pain,swelling,dysfunction,deformity and so on.Conclusion The fixed platform stabilized prosthesis is simple,effective,and less postoperative complications,and it is a better choice for the elderly patients with high flexion activity.