全膝置换术治疗类风湿与退变性膝关节炎的比较研究

Comparison of the Early Metaphase Efficacy of Total Knee Arthroplasty for the Treatment of Rheumatoid Arthritis and Degenerative Arthritis of the Knee

目的探讨全膝关节置换术(total knee arthroplasty,TKA)治疗类风湿性膝关节炎(rheumatoid arthritis of the knee,RA)与退变性膝关节炎(osteoarthritis,OA)术后疗效差异。方法回顾分析2006年12月至2013年12月初次采用TKA治疗类风湿性与退变性膝关节炎患者68例(68膝)的临床资料。其中男12例,女56例;年龄40~84岁,平均(61.6±9.7)岁。按原发疾病不同将患者分为RA组34例(34膝)和OA组34例(34膝)。记录所有患者术中出血量、手术时间、术后引流量、输血量、术后股四头肌肌力恢复时间、术后下地时间、术后助行器使用时间、弃拐时间、住院时间、跛行步态消失的时间、术后患肢肿胀消失时间、术后并发症。采用美国特种外科医院膝关节(the hospital for special surgery,HSS)评分系统、膝关节活动度(range of motion,ROM)、视觉模拟评分(visual analogue score,VAS)、主观满意度等作为最终评价手术临床疗效的依据。根据影像学表现观察假体周围透亮线作为判断假体有无松动的依据。结果所有患者均获得随访,随访时间24~96个月,平均40.6个月。两组患者在年龄、病程、术中出血量、手术时间、术后引流量、输血量、术后股四头肌肌力恢复时间、术后下地时间、术后助行器使用时间、弃拐时间、住院时间、跛行步态消失时间、术后患肢肿胀消失时间之间的差异均有统计学意义(P<0.05)。术后6个月,两组患者的HSS评分、ROM、VAS疼痛评分的差异有统计学意义(P<0.05),而主观满意度的差异无统计学意义(P>0.05);而在末次随访时两组患者的HSS评分、ROM、VAS疼痛评分,主观满意度的差异均无统计学意义(P>0.05)。X线片未显示髌骨轨迹不良及假体无菌性松动、下沉等。其中,RA组术后症状性下肢深静脉血栓1例,关节僵硬1例,皮肤浅层感染2例,伸膝无力1例;OA组术后关节僵硬1例,无深静脉血栓、皮肤浅层感染、伸膝无力等并发症。结论TKA治疗RA患者围手术期疗效及术后早期疗效较OA患者差,但两者早中期随访疗效无差异,均能取得满意的临床疗效。

Objective To compare the efficacy of total knee arthroplasty（TKA）for the treatment of rheumatoid arthritis and degenerative arthritis of the knee.Methods Clinical data of 68cases（68knees）with rheumatoid arthritis and degenerative arthritis of the knee who had undergone primary TKA procedure from December 2006 to December 2013 were retrospectively analyzed.There were 12 males and 56 females,aged from 40 to 84years,with an average age of（61.6±9.7）years.They were divided into RA group and OA group by the different primary diseases.peroperative bleeding,operation time,postoperative drainage volume,intraoperative and postoperative blood transfusion,recover time of muscle strength of four head of femur after operation,walking without stick time,postoperative aid use time,leaving a sickbed time,hospitalization time,claudication disappear time,postoperative limb swelling disappeared time,postoperative complication were recorded.Clinical evaluation of Arthroplasty has been made by referring to the Hospital for special surgery system、the Range of motion、the VAS pain scoring,the subjective satisfaction.According to the imaging observation of periprosthetic radiolucency component loosening as a judgment basis.Results All patients were followed up for 24 to 96months（average 40.6 months）.There were statistically significant between two groups in age,course of disease,peroperative bleeding,operation time,postoperative drainage volume,intraoperative and postoperative blood transfusion,recover time of muscle strength of four head of femur after operation,walking without stick time,postoperative aid use time,leaving a sickbed time,hospitalization time,claudication disappear time,postoperative limb swelling disappeared time（P〈0.05）.Among them,In 6months after the operation,two groups of patients with HSS score,ROM,VAS pain score difference were statistically significant（P〈0.05）,and there was no significant difference in subjective satisfaction.At the last follow-up,there were no significant difference in HSS score、VAS pain score and subjective satisfaction.NO patellar and prosthetic loosening or infection was observed according to X-ray.In RA group：one case appeared postoperative deep venous thrombosis symptoms,one case had joint stiffness early,two cases had superficial infection,one case had extensor weakness.In OA group：one case had joint stiffness early,no DVT,superficial infection of the skin,inability to extend the knee and other complications.Conclusion TKA treatment of RA in patients with peri operative efficacy and postoperative early curative effect is worse than OA,but eventually the two early midterm no difference can achieve satisfactory clinical efficacy.