全膝关节置换术治疗合并帕金森病骨关节炎患者的中期随访和临床疗效分析

Mid-term follow-up and clinical efficacy of total knee arthroplasty for osteoarthritis patients with Parkinson's disease

目的 :探讨全膝关节置换术治疗伴有帕金森病的膝关节骨关节炎的患者的中期随访的临床疗效及经验总结。方法:收集自2011年1月至2014年1月收治19例(21膝)全膝关节置换术治疗帕金森合并膝关节骨性关节炎的患者,其中男9例,女10例;年龄61~83岁,平均71.3岁,术前及术后查影像学结果,评估影像学表现。采用VAS疼痛评分及膝关节评分系统KSS评价临床效果。术前对患者进行帕金森病Hoehn-Yahr分级:1期3例,1.5期4例,2期5例,2.5期4例,3期2例,4期1例。结果:19例患者获得随访,时间3~7年,平均4.3年。患者疼痛均较术前明显减轻或消失。所有患者切口Ⅰ期愈合。末次随访时,3例有膝前疼痛,其中轻度疼痛1例,中度2例,无重度疼痛。患者VAS评分由术前的8.4±1.3降低到末次随访时的3.1±1.2(P<0.05)。KSS评分由术前的43.6±7.3提高到末次随访时的91.8±10.6(P<0.05)。帕金森病情在药物控制下进展不明显。X线检查未见假体松动及下沉断裂。结论:人工全膝关节置换术在帕金森病人中的应用是一种安全有效的方法。中期随访疗效较满意。

Objective： To investigate clinical efficacy and experience of total knee arthroplasty in treating knee osteoarthritis patients with Parkinson＇s disease. Methods： From January 2011 to January 2014,19 knee osteoarthritis patients with Parkinson＇s disease treated with total knee arthroplasty were collected. Among them,including 9 males and 10 females aged from 61 to 83 years old with an average of 71.3 years old. Radiology results were checked before and after operation. VAS score and KSS score were applied to evaluate clinical effects. Patients were classified according to HoehnYahr grade,3 cases in grade 1,4 cases in grade 1.5,2 cases in grade 2,4 cases in grade 2.5,2 cases in grade 3 and 1 case in grade 4. Results： Nineteen patients were followed up from 3 to 7 years with an average of 4.3 years. The pain of patients was significantly reduced or disappeared. All incisions were healed at stageⅠ. At the latest follow-up,3 patients had knee pain,and mild pain in 1 patient,moderate in 1 patient without severe pain. VAS score was reduced from preoperative 8.4±1.3 to the latest follow-up 3.1±1.2,the difference was statistically significant （P〈0.05）. KSS score improved from 43.6±7.3 before operation to 91.8±10.6 after operation. The condition of Parkinson＇s were controlled by medicine. No loosening and subsidence of prosthesis by X-ray examination. Conclusion： Total knee arthroplasty is a safe and effective method for the treatment of Parkinson＇s disease and has satisfactory mid-term clinical effect.