膝关节表面置换术治疗重度痛风性膝关节炎的疗效观察

Clinical observation on treatment of knee arthroplasty for severe gouty arthritis of knee

目的探讨重度痛风性膝关节炎行人工全膝关节置换术的特点、疗效和围手术期的注意事项。方法追踪2008年1月至2014年6月在中山大学附属第一医院关节外科行人工膝关节表面置换术治疗23例28膝经保守治疗不能缓解其疼痛且有明显的影像学改变的痛风性膝关节炎患者,置换后均获得2年以上的随访,记录术前、术后1周、3个月、12个月、24个月的美国膝关节协会评分(KSS评分)及膝关节X光片,各时间点的疗效指标的比较采用重复测量设计资料的方差分析。结果所有患者置换术中及置换后无严重并发症。术后1周、3个月、12个月及术后24个月随访时疼痛的视觉模拟评分(F=31.76,P<0.01),KSS评分(F=106.54,107.85,P<0.01)、膝关节活动度(F=104.78,P<0.01)均较术前有明显改善,所有患者置换后X射线片均示假体位置良好,下肢力线满意,无透亮线及任何松动迹象。结论通过围手术期全面规范处理、快速康复及系统的功能锻炼,人工全膝关节表面置换术治疗晚期痛风性膝关节炎近期疗效满意。

Objective To explore features,efficacy and precautions during perioperation period for patients with severe gouty arthritis who received total knee arthroplasty(TKA).Methods Twenty-eight knees of 23 gouty arthritis patients who received artificial TKA after failed pain relief by conservative treatment and occurrence of obvious imaging changes in Joint Surgery Department,the First Affiliated Hospital Sun Yat-Sen University during January 2008 and June 2014 were traced.All the patients received over two years’follow-up treatment after replacement and American knee society score(KSS)of knee and visual analogue scale(VAS)before operation and one week,three months,twelve months and twenty four months after operation,as well as X-ray films of knee joint were recorded.Variance analysis of repeated measurement design was taken for the comparison of efficacy indices at different timing.Results No severe complication was seen among all the patients during the surgery and perioperative period.VAS score at one week,three months,twelve months and twenty four months after the surgery(F=31.76,P<0.01),KSS score(F=106.54,107.85,P<0.01)and activity of joint knee(F=104.78,P<0.01)were significantly improved compared to that before surgery.X ray films of all the patients after surgery indicated good location of prosthesis,satisfactory limb alignment and no bright line and any aseptic loosening signs.Conclusion Satisfactory short-term efficacy of artificial TKA in treating advanced gouty arthritis may achieve through comprehensive and regulated disposal,rapid rehabilitation and systemic functional exercise during perioperative period.