人工全膝关节置换术治疗成人晚期膝关节大骨节病的效果

Clinical efficacy of total knee arthroplasty in treatment of end-stage Kashin-Beck disease in adults

目的观察全膝关节置换术(TKA)治疗成人晚期膝关节大骨节病(KBD)的临床效果。方法选取2014年5月～2016年12月陕西省人民医院收治的晚期膝关节KBD患者24例(29膝),均初次采用TKA治疗。根据患者实际情况选择合适假体及手术入路。观察患者手术前后疼痛视觉模拟评分(VAS)、美国膝关节协会评分(KSS)、膝关节活动度(ROM)、股胫角(FTA)变化及术后并发症发生情况,术后随访1～15个月。结果术后各时段VAS评分、FTA均较术前显著降低,KSS及ROM均较术前显著升高,差异有统计学意义(P <0.05),1例出现肌间静脉血栓,经抗凝治疗痊愈;术后均无肺栓塞和深静脉血栓等严重并发症出现,未出现假体周围透明带、假体下沉或松动。结论 TKA治疗晚期膝关节KBD效果满意,显著减轻膝关节疼痛,获得满意的膝关节活动范围及功能。

Objective To observe the clinical efficacy after total knee arthroplasty(TKA)for the end-stage Kashin-Beck disease(KBD)in adults.Methods From May 2014 to December 2016,in Shaanxi Provincial People's Hospital,24 patients(29 knees)with the end-stage KBD and treated with total knee arthrophasty(TKA)at first time were selected.Appropriate prosthesis and surgical approach were selected according to patients′condition.The changes of Visual analogue scale(VAS)score,Knee society score(KSS),knee range of motion(ROM),femorotibial angle(FTA)and postoperative complications were observed before and after TKA,the patients were followed up for 1-15 months.Results In each period after surgery,the VAS score and FTA decreased significantly compared with that before surgery,KSS and ROM increased significantly compared with those before surgery,the differences were statistically significant(P<0.05).One case occured muscular venous thrombosis,and was cured by anticoagulation therapy.No serious complications were noted,such as pulmonary embolism,deep vein thrombosis,periprosthetic osteolysis,prosthetic sinking or loosening.Conclusion TKA is an effective treatment for end-stage KBD of the knee joint.It can significantly reduce pain of knee joint,and obtain satisfactory activity range and function of the knee joint.