全膝关节置换术治疗成人严重膝关节大骨节病的疗效评价

Clinical evaluation of total knee arthroplasty in treatment of severe adult Kashin-Beck disease

目的评价全膝关节置换术治疗成人严重膝关节大骨节病的临床效果。方法2013年1月至2015年12月，在陕西省人民医院接受全膝关节置换术的膝关节大骨节病患者16例，其中男性2例（2个膝关节），女性14例（17个膝关节）；平均年龄（56．38±6．40）岁，范围为41～56岁；左膝关节8例，右膝关节11例；膝内翻畸形15例，膝外翻畸形4例。观察膝关节置换前后疼痛视觉模拟量表（VAS）评分、膝关节HSS评分、膝关节活动度、内外翻畸形矫正、术后并发症发生的情况。结果16例患者术前，术后2周、3个月、末次随访VAS评分分别为（7．51±1．00）、（3．56±1．29）、（1．83±1．40）、（1．10±0．87）分，术后2周VAS评分低于术前（P〈0．01），且术后VAS评分随时间增加逐渐降低（P均〈0．01）。术后末次随访HSS总评分为（78．60±5．30）分，显著高于术前[（43．59±10．08）分，t=19．21，P〈0．01]；除肌力外，术后末次随访的疼痛、功能、活动度、屈曲畸形和稳定性评分[（25．94±4．17）、（15．88±3．70）、（14．09±1．03）、（6．79±2．25）、（8．58±1．30）分]均显著高于术前[（11．56±5．39）、（7．56±1．75）、（9．86±3．85）、（3．05±3．22）、（5．00±3．07）分，t=16．00、8．32、6．43、7．07、6．95，P均〈0．01]。术后末次随访膝关节伸直度[（3．05±2．71）°]显著低于术前[（15．11±11．30）°，t=-5．40，P〈0．01]，膝关节最大屈曲度[（115．79±9．65）°]显著高于术前[（93．95±22．40）°，t=6．02，P〈0．01]，膝关节内翻度[（2．40±2．40）°]及外翻度[（3．75±2．50）°]显著低于术前[（11．33±10．43）°、（18．00±5．72）°，t=-4．15、-3．61，P均〈0．05]。1例患者于术后6个月确诊为膝关节结核，其他患者术后无并发症发生。结论全膝关节置换术治疗成人严重膝关节大骨节病可显著减轻膝关节疼痛症状，纠正关节畸形，改善膝关节功能，提高患者生活质量，临床疗效显著。

Objective To evaluate the clinical effects of total knee arthroplasty （TKA） in treatment of severe adults Kashin-Beck disease （KBD）. Methods Sixteen cases of KBD patients underwent TKA in Shaanxi Provincial People＇s Hospital, including 2 males （2 knees） and 14 females （17 knees）, aged 41 to 56 years, mean （56.38 ± 6.40） years, left knee in 8 cases and right knee in 11 cases, knee varus in 15 cases and valgus knees in 4 cases. Visual Analogue Scale/Score （VAS）, Hospital for Special Surgery （HSS） scores, knee range of motion, varus deformity and postoperative complications were observed before and after TKA. Results In this group of TKA patients, the levels of VAS scores in pre-total knee arthroplasty （pre-TKA）, 2 weeks post-total knee arthroplasty （post-TKA）, 3 months post-TKA, and at the end of the fallow-up were 7.51 ± 1.00, 3.56 ± 1.29, 1.83 ± 1.40 and 1.10 ± 0.87, respectively. The level of VAS scores in 2 weeks post-TKA was significantly lower than that in pre- TKA （P 〈 0.01）, and the VAS levels were continued to decrease in post-TKA （all P 〈 0.01）. Total HSS score at the end of the follow-up post-TKA was 78.60 ± 5.30, which was significantly higher than that in pre-TKA （43.59 ± 10.08, t = 19.21, P 〈 0.01）. At the end of the follow-up post-TKA, in addition to the muscle strength, the levels ofpain, knee function, activity, flexion deformity and stability （25.94 ± 4.17, 15.88 ± 3.70, 14.09 ± 1.03, 6.79 ± 2.25, 8.58 ± 1.30） were significantly higher than those in pre-TKA （11.56 ± 5.39, 7.56 ± 1.75, 9.86 ± 3.85, 3.05 ± 3.22, 5.00 ± 3.07, t = 16.00, 8.32, 6.43, 7.07, 6.95, all P 〈 0.01）. At the end of follow-up post-TKA, the knee degree of extension [（3.05 ± 2.71）±] was significantly lower than that in pre-TKA [（15.11 ± 11.30）°, t = - 5.40, P 〈 0.01], the knee degree of flexion [（1 15.79 ± 9.65）°] was significantly higher than that in pre-TKA [（93.95 ± 22.40）°, t = 6.02, P 〈 0.01）, the degree of varus [（2.40 ± 2.40）°] and valgus [（3.75 ± 2.50）°] deformity was significantly lower than those in pre-TKA [（11.33 ± 10.43）°, （18.00 ± 5.72）°, t = - 4.15, - 3.61, all P 〈 0.05]. One patient was diagnosed as knee tuberculosis in 6 months post-TKA. There was no complication in this group of patients. Conclusion The TKA in severe adults knee of KBD can significantly reduce knee pain, improve knee function, correct joint deformities and improve quality of life in patients, and shows good clinical results.