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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (04) : 419 -425. doi: 10.3877/cma.j.issn.1674-134X.2019.04.006

所属专题： 文献；

临床论著

活动期类风湿关节炎行膝关节置换的安全性与有效性
甄平1,†(), 李旭升1, 周胜虎1, 刘军1   
  1. 1. 730050　兰州，解放军联勤保障部队第940医院（原兰州军区总医院）骨科中心关节外科
  • 收稿日期:2017-06-27 出版日期:2019-08-01
  • 通信作者: 甄平
  • 基金资助:
    国家自然科学基金(81371983); 甘肃省青年科技基金(18JR3RA410)

Safety and efficacy of total knee arthroplasty in treatment of active rheumatoid arthritis

Ping Zhen1,†(), Xusheng Li1, Shenghu Zhou1, Jun Liu1   

  1. 1. Department of Orthopaedic, The General Hospital of PLA, Lanzhou 730050, China
  • Received:2017-06-27 Published:2019-08-01
  • Corresponding author: Ping Zhen
  • About author:
    Corresponding author: Zhen Ping, Email:
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引用本文：

甄平, 李旭升, 周胜虎, 刘军. 活动期类风湿关节炎行膝关节置换的安全性与有效性[J]. 中华关节外科杂志(电子版), 2019, 13(04): 419-425.

Ping Zhen, Xusheng Li, Shenghu Zhou, Jun Liu. Safety and efficacy of total knee arthroplasty in treatment of active rheumatoid arthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(04): 419-425.

目的

探讨活动期类风湿性关节炎进行膝关节置换手术(TKA)的安全性与有效性。

方法

2010年10月至2015年3月兰州军区总医院对35例(45膝)活动期类风湿性膝关节炎的患者进行人工膝关节置换手术，男10例(10膝)，女25例(35膝)；平均年龄(55±9)岁。排除全身发热、不耐受手术者。分别在手术治疗前、治疗后1年和2年检测类风湿因子、红细胞沉降率和C－反应蛋白水平，膝关节功能评定采用美国膝关节协会(KSS)关节功能评分标准。记录膝关节置换术后关节疼痛肿胀以及术后并发症情况。应用SPSS 21. 0统计学软件对数据进行统计学分析，采用配对样本t检验比较手术治疗前后膝关节功能和生化指标变化情况。

结果

本组35例(45膝)均获得随访，随访时间(4.2±1.6)年。膝关节置换术后2年类风湿因子、红细胞沉降率和C－反应蛋白水平与手术前相比有明显下降，差异有统计学意义。膝关节活动度由术前(53±13)°(42°～67°)术后提高至末次随访时的(93±11)°(82°～104°)，差异有统计学意义(t＝27.461，P<0.01)；膝关节KSS评分从术前平均(56±10)分提高至末次随访时平均(88±8)分，差异有统计学意义(t＝68.731，P<0.01)。术后受累关节类风湿关节炎症状均显著改善，主要表现在疼痛、肿胀和主观感受等方面。随访期间无伤口裂开、延期愈合、感染以及假体松动的发生，1例术后第3天进行膝关节屈伸功能锻炼时发生股骨远端假体周围骨折，行切开复位钢板内固定。

结论

活动期类风湿性关节炎行TKA手术安全可靠，正确的围手术期评估与干预、有效的膝关节病变滑膜切除、精准的手术操作可有效降低TKA外科治疗风险。

关键词: 关节炎，类风湿性, 膝，关节置换, 安全性
Objective

To evaluate the safety and efficacy of total knee arthroplasty in treatment of rheumatoid arthritis in active stage.

Methods

Thirty-five patients (45 knees) with rheumatoid arthritis in active stage had undergone total knee arthroplasty (TKA) in Lanzhou Ganeral Hospital of PLA with at least two years follow-up from October 2010 to March 2015. There were 10 men (10 knees) and 25 women (35 knees), with an average age of (55±9) years. The patients with fever whocouldnot accepte operation were excluded. The rheumatoid factor, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels of the patients were measured before treatment, one and two years after TKA treatment, and the KSS joint function scoring criteria was used to assess the functions. The symptoms and complications were also recorded. The data were statistically analyzed by SPSS 21.0 statistical software with pair-t test to compare the rheumatoid factor, ESR and CRP levels, so as the knee functions.

Results

All the patients were followed up for average (4.2±1.6)years. Two years after TKA treatment, the indicators (rheumatoid factor, ESR, CRP) at two years after TKA treatment were significantly lower than those before treatment (P <0.01). All the functions of the knee joint were improved after TKA.The range of knee motion was improved from (53±13)°(42°-67°) to preoperative (93±11)° (82°-104°) at two years fellow up (t=27.461, P <0.01). The KSS knee score was improved from the preoperative (56±10) to the (88±8) at the last follow-up examination, and there was statistical difference between preoperative results and the results of the latest follow-up (t =68.731, P <0.01). No patients suffered wound dehiscence, delayed healing, infection and prosthesis loosening in follow-up.

Conclusion

TKA is safety and efficacy in treating the RA patients with active stage. Detailed evaluation and multidisciplinary cooperation at perioperative period, effective synovectomy of knee and correct TKA manipulation are necessary to reduce the risk of TKA surgery.

Key words: Arthritis, rheumatoid, Arthroplasty, replacement, knee, Safety
图2 截骨断面严重骨质疏松
图3 双膝活动期类风湿性关节炎行全膝关节置换术前后X线正位片。图A为术前双膝正位X线片，示双膝外翻畸形，关节间隙消失，局部严重骨质疏松；图B为术后双下肢全长正位X线片，示髋－膝－踝角左侧178°(角偏差2°)，右侧179 °(角偏差1°)
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