类风湿关节炎和骨关节炎患者膝关节置换术后并发症的临床对照研究

Comparison of postoperative complications of knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis

目的 :对比骨性关节炎(osteoarthritis,OA)和类风湿关节炎(rheumatoid arthritis,RA)患者膝关节置换术后并发症发生情况。方法 :选取67例RA和78例OA患者,均行膝关节置换术治疗,观察并记录患者的术前,术后3d和5d的VAS评分、ROM评分,随访2年期间并发症发生情况,对比OA和RA患者膝关节置换术后并发症发生情况。结果 :与术前相比,RA组术后5d的VAS评分明显降低,OA组术后3d,5d的VAS明显降低,OA组术后3d,5d的VAS评分明显低于RA组。术前两组ROM评分无统计学差异,与术前相比,RA组术后3 d的ROM评分明显降低,OA组术后5d的ROM评分明显增加,OA组术后3d,5d的ROM评分明显高于RA组,随访2个年期间,RA组2年内翻修率和伤口并发症发生率均明显高于OA组,关节失稳,假体松动,下肢深静脉血栓发生率比较,无统计学差异。两组主要伤口并发症为伤口渗液,发生率相比无统计学差异。其他3种并发症发生率相比,也没有统计学差异。结论 :骨关节炎患者经人工膝关节置换术治疗后,并发症发生较少,膝关节活动较术前改善明显,疼痛度减轻。

Objective Comparing postoperative complications of knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis. Methods 67 patients withRA and 78 patients with OA were selected, they were given knee joint replacement treatment. The postoperative complications of knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis were evaluated by VAS scores before operation, after 3 days and 5 days operation, ROM scores and complications during 2 years follow-up. Results Compared with the scores before operation, the VAS scores were decreasedafter 5 days operation in the RA group. The VAS scores were decreased after 3 days and 5 days operation in the OA group. In the OA group, the VAS scores were lower than that of the RA group after 3 days and 5 days operation. Compared with the scores before operation, the ROM scores after 3 days operation were decreased in the RA group. The ROM scores were increased after 5 days operation in the OA group. In the OA group, the ROM scores were higher than that of the RA group after 3 days and 5 days operation. During 2 years follow-up, the rate of revision and wound complication of RA group were higher than that of the OA group. There were no statis-tical significance on the joint instability, prosthesis loosening and deep venous thrombosis of lower extremity. The major wound complication was wound infiltration and there were no statistical significance on complications between two groups. There were no statistical significance on the rest of complication rate. Conclusion After operation, the complications were less in osteoar-thritis patients. The knee joint motion was improved obviously and the pain was reduced.