类风湿性与骨性关节炎全膝置换围手术期比较

Comparison of the perioperative outcomes of total knee arthroplasty for rheumatoid arthritis and osteoarthritis

[目的]比较类风湿性关节炎(rheumatoid arthritis, RA)和骨性关节炎(osteoarthritis, OA)全膝置换术(total knee arthroplasty, TKA)的围手术期临床与检验结果。[方法] 2019年3月—2019年9月在本院关节科因RA或OA行单侧TKA并有完整围手术期临床与检验资料的115例患者纳入本研究。比较两组临床与检验资料。[结果]两组患者均顺利完成手术,术中无严重并发症。两组手术时间、切口长度差异无统计学意义(P>0.05),但RA组术中失血量显著大于OA组(P<0.05)。术后3 d RA组的VAS评分显著大于OA组(P<0.05)。检验方面,与术前相比,术后3 d两组DD、Fib、ESR、CRP均显著升高(P<0.05)。术前RA组的DD和Fib显著高于OA组(P<0.05),术后3 d RA组的DD仍高于OA组,但差异无统计学意义(P>0.05),而RA组的FIB显著高于OA组(P<0.05)。[结论] TKA可有效治疗RA和OA,相比之下,RA术中失血量显著大于OA,这与RA的炎症指标显著高于OA有关。

[Objective] To compare the perioperative clinical and laboratory test outcomes of total knee arthroplasty(TKA) for rheumatoid arthritis(RA) and osteoarthritis(OA). [Methods] From March 2019 to September 2019, 115 patients who underwent unilateral TKA for RA or OA in our hospital, and had complete perioperative clinical and laboratory data were included in this study. The clinical and laboratory data of the two groups were compared. [Results] All patients in both groups were successfully operated on, without serious complications.Although there was no significant difference in operation time and incision length between the two groups(P>0.05), the RA group had significantly greater intraoperative blood loss than the OA group(P<0.05). The RA group was marked significantly higher VAS score than the OA group at 3 days after operation(P<0.05). In terms of laboratory test, the D-dimer(DD) and fibrinogen(FIB) in both groups increased at 3days after operation compared with those before operation, whereas which was not statistically significant(P>0.05), by contrast, the erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) significantly increased in both groups(P<0.05). The RA group had significantly higher preoperative DD and FIB than the OA group(P<0.05), nevertheless which became not statistically significant between the two groups3 days after operation(P>0.05). However, the RA group had significantly higher ESR and CRP than the OA group preoperatively and 3 days postoperatively(P<0.05). [Conclusion] TKA does effectively treat both RA and OA. In contrast, the RA has significantly greater intraoperative blood loss than the OA, which might be related to the significantly higher inflammatory marker in the RA over the OA.