人工关节置换术治疗晚期血友病性关节炎

Artificial joint replacement for treatment of advanced hemophilic arthritis

目的评价人工关节置换术治疗髋、膝关节晚期血友病性关节炎的临床疗效,探讨围手术期凝血因子替代治疗方法、手术方式及术后并发症的处理。方法回顾性分析自2010-06—2017-04采用人工关节置换术治疗的血友病性关节炎12例,髋关节3例(4髋)行全髋关节置换术,膝关节9例(11膝)行全膝关节置换术。围手术期10例甲型血友病凝血因子替代治疗首选基因重组FⅧ制剂,2例乙型血友病凝血因子替代治疗选用冻干人凝血酶原复合物康舒宁。结果 12例均获得随访,随访时间平均32(6~60)个月。所有患者随访期间未发生关节感染,未出现假体脱位及松动,假体位置及力线满意。末次随访时全髋关节置换者髋关节功能Harris评分由术前平均42分提高至平均88分,疼痛VAS评分由术前平均7.5分降低至2.8分,关节活动度明显改善。末次随访时全膝关节置换者膝关节功能HSS评分由术前平均46分提高至平均83分,疼痛VAS评分由术前平均8.5分降低至2.5分,关节活动度由术前平均45.0°改善至86.2°,屈曲畸形由术前平均20.5°改善至5.0°。结论在足够的凝血因子替代治疗的前提下,人工关节置换术是治疗晚期血友病性关节炎的有效手段,可以显著减轻关节疼痛、改善关节功能,大大提高患者的生存质量。

Objective To evaluate the clinical effect of artificial joint replacement in the treatment of advanced hemophilia arthritis of hip and knee joints, and to explore the coagulation factor replacement therapy perioperatively, the operative characteristics and the postoperative complications. Methods Twelve cases of hemophilic arthritis treated by artificial joint replacement from June 2010 to April 2017 were analyzed retrospectively. Nine patients （11 knees） underwent total knee arthroplasty, and 3 patients （4 hips） total hip arthroplasty. For 10 cases of hemophilia A, V~ factor was the first choice of coagulation factor replacement therapy during perioperative period. For 2 cases of hemophilia B, lyophilized human prothrombin complex concentrate-Kang Shuning was used for coagulation factor replacement therapy. Results All of the cases were followed up for an average period of 32 months （range, 6-60 months）. All patients had no joint infection during the follow-up period, no prosthesis dislocation and loosening, and the location and force line of prosthesis were satisfactory. The average Harris score of the total hip replacement patients increased from 42 preoperatively to 88 at the last follow up, the VAS pain score decreased from 7.5 to 2.8, and the activity of joints improved significantly. The average HSS score of total knee arthroplasty patients increased from 46 to 83, the VAS pain score decreased from 8.5 to 2.5, the range of motion of the joint improved from 45.0 degrees before operation to 86.2 degrees after operation, and the flexion deformity improved from 20.5 degrees before operation to 5.0 degrees postoperatively. Conclusion Under the premise of sufficient coagulation factor replacement therapy, artificial joint replacement is an effective method for the treatment of advanced hemophilic arthritis. It can significantly reduce joint pain, improve joint function, and greatly improve the quality of life of the patients.