肘关节置换治疗晚期肘关节类风湿性关节炎临床疗效分析

Clinical Analysis of Elbow Arthroplasty in The Treatment of Advanced Elbow Toint Rheumatoid Arthritis

目的分析人工肘关节置换在治疗晚期肘关节类风湿性关节炎的临床疗效。方法选取自2012年1月至2018年6月于江苏省中医院骨伤科治疗的11例肘关节类风湿性关节炎患者为研究对象,11例患者均为单侧,均行人工肘关节置换术。其中男性3例,女性8例;年龄46~91岁,平均(59.55±12.28)岁。比较患者术前、术后10 d、术后3个月、末次随访时的肘关节Mayo评分、C反应蛋白、类风湿因子、血沉水平、并发症发生情况。结果全部患者均获完整随访,随访时间为12~66个月,平均(26.6±15.1)个月。患者术前、术后10 d、术后3个月和末次随访时的Mayo评分平均值分别为(30.91±9.86)分、(62.00±5.22)分、(85.55±6.93)分和(91.93±4.01)分,疼痛评分分别为(16.00±7.68)分、(25.27±3.29)分、(38.18±4.05)分和(41.83±2.31)分,运动功能评分分别为(3.27±1.85)分、(14.00±2.14)分、(17.54±2.16)分和(18.11±1.61)分,术后各时期与术前比较差异有统计学意义(P<0.05);且术后的类风湿因子、血沉水平均呈下降趋势,C反应蛋白在术后10d稍有上升,术后3个月及末次随访时均较术前下降;X线片复查示随访期间无假体磨损、松动及断裂、假体位置异常、假体周围骨折、异位骨化等发生,假体存活率100%。患者术后均无感染及神经损伤,术后切口愈合困难1例(9.11%),经换药3周后愈合。随访期间出现肘关节周围疼痛1例(9.11%),给予止痛药物及功能训练后缓解。患者均康复出院,末次随访均未出现明显其他并发症。结论人工肘关节置换术治疗晚期肘关节类风湿性关节炎疗效显著,有利于改善患者肘关节功能,减轻炎症反应,且安全性高,值得推广。

Objective To analyze the clinical efficacy of total elbow arthroplasty in the treatment of advanced elbow joint rheumatoid arthritis.Methods Eleven patients with elbow joint rheumatoid arthritis treated in the Department of Orthopedics in Jiangsu Provincial Hospital of TCM from January 2012 to June 2018 were selected.All 11 patients were unilateral and all patients underwent total elbow arthroplasty.There were 3 males and 8 females;the age ranged from 46 to 91 years,with an average age of(59.55±12.28)years.The Mayo score,C-reactive protein,rheumatoid factor,erythrocyte sedimentation rate and complications of the elbow joint were compared before surgery,10 days after surgery,3 months after surgery and last follow-up.Results All patients were followed up for 12~66 months with an average of(26.6±15.1)months.The Mayo scores of patients before surgery,10 days after surgery,3 months after surgery and last follow-up were(30.91±9.86),(62.00±5.22),(85.55±6.93),and(91.93±4.01),respectively.The pain scores were(16.00±7.68),(25.27±3.29),(38.18±4.05),and(41.83±2.31),respectively.The motor function scores were(3.27±1.85),(14.00±2.14),(17.54±2.16),and(18.11±1.61),respectively,the postoperative period was significantly improved compared with preoperative and preoperative.The postoperative rheumatoid factor and erythrocyte sedimentation rate showed a downward trend,and C-reactive protein increased slightly on the 10th postoperative day.The postoperative 3 months after surgery and last follow-up decreased compared with the preoperative period.X-ray films showed no prosthesis wear,loosening and rupture during the follow-up period,abnormal position of the prosthesis,periprosthetic fracture,heterotopic ossification,etc.Survival rate was 100%.There was no infection after operation,no nerve injury,and the incision was difficult to heal in 1 case(9.11%).The incision healed after dressing for 3 weeks.Pain around the elbow occurred during follow-up was found in 1 case(9.11%)and relieved by administration of analgesic drugs and functional training.All patients were discharged from hospital,and no other complications occurred at the last follow-up.Conclusion Artificial total elbow arthroplasty is effective in the treatment of advanced elbow joint rheumatoid arthritis,which is beneficial to improve the elbow joint function and reduce inflammation in patients,and it is safe and worth promotion.