类风湿关节炎行关节置换术围手术期管理的研究进展

Perioperative and drug management of patients with rheumatoid arthritis treated with joint replacement

类风湿关节炎是最常见的炎性关节病,尽管目前类风湿关节炎缓解药物不断改进,药效却只能延缓关节功能障碍的进展。人工膝或髋关节置换术现已成为晚期类风湿关节炎患者的惟一选择,经手术治疗后患者的关节功能及畸形问题可得到不同程度改善。但类风湿关节炎的病程持续进展直接影响术后的远期效果,如何完善围手术期管理,将关节置换术与药物治疗有效结合逐渐成为临床工作者关注的重点。本文拟通过对行关节置换术类风湿关节炎患者的术前药物使用、术中手术技巧、假体选择、术后治疗、康复锻炼及并发症等国内外管理现状加以概括总结,为提高此类患者远期疗效及生活质量提供有益帮助。

Rheumatoid arthritis（RA） is a most common inflammatory joint disease with direct invasion of joint synovial membrane,cartilage and bone. Currently,although the RA mitigation drugs are being improved continously,but these drugs only can delay the development of joint dysfunction. Total hip arthroplasty or total knee arthroplasty（THA or TKA） has become the only choices for patients with advanced RA,and the joint function and deformity of the patients after surgical treatment can be improved to some extent. However,the progression of RA has a direct effect on the long term clinical effect of the surgery,and how to improve perioperative management,and combine the joint replacement surgery and drug therapy effectively,have become the focus of attention in clinical doctors. This article intends to summarize the current situation of domestic and foreign management of usage of pre operative drugs,operation skills,prosthesis selection,postoperative treatment,rehabilitation and complications,so as to improve the long term efficacy of joint replacement.