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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) ›› 2020, Vol. 14 ›› Issue (03) : 303 -307. doi: 10.3877/cma.j.issn.1674-134X.2020.03.008

所属专题： 文献；

临床论著

重度屈曲畸形膝关节置换术后康复效果研究
韩伟1, 张舒1,†(), 邢丹2, 李虎2, 寇伯龙2   
  1. 1. 100075　北京市东城区第一人民医院骨科
    2. 100044　北京大学人民医院骨关节科
  • 收稿日期:2019-08-19 出版日期:2020-06-01
  • 通信作者: 张舒

Effect of functional rehabilitation of rheumatoid arthritis patients with severe flexion contracture after knee replacement

Wei Han1, Shu Zhang1,†(), Dan Xing2, Hu Li2, Bolong Kou2   

  1. 1. Department of Orthopedics, The First People’s Hospital of Dongcheng, Beijing 100075, China
    2. Department of Joint Surgery, Peking University People’s Hospital, Beijing 100044, China
  • Received:2019-08-19 Published:2020-06-01
  • Corresponding author: Shu Zhang
  • About author:
    Corresponding author: Zhang Shu, Email:
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韩伟, 张舒, 邢丹, 李虎, 寇伯龙. 重度屈曲畸形膝关节置换术后康复效果研究[J]. 中华关节外科杂志(电子版), 2020, 14(03): 303-307.

Wei Han, Shu Zhang, Dan Xing, Hu Li, Bolong Kou. Effect of functional rehabilitation of rheumatoid arthritis patients with severe flexion contracture after knee replacement[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(03): 303-307.

目的

评价类风湿性关节炎伴膝关节重度屈曲畸形患者行人工膝关节置换术后康复措施的临床效果。

方法

回顾性分析2013年6月至2017年9月收治的21例(36膝)类风湿性关节炎伴膝关节重度屈曲畸形患者在人工膝关节置换术后进行功能康复治疗的疗效情况。纳入标准为类风湿关节炎伴膝关节屈曲挛缩角度达60°以上患者，排除标准为存在其它继发性膝骨关节炎者。对所有患者实施系统康复治疗。评估术后、康复出院时以及末次随访的疼痛视觉模拟评分(VAS评分)，膝关节屈曲挛缩角度以及膝关节活动范围，进而评估术后康复措施的疗效。根据数据是否符合正态分布，多组间定量资料比较采用单因素方差分析或Friedman秩和检验。

结果

在21例患者中，15例(26膝)获得随访，随访时间平均(46±15)个月。术后膝关节VAS评分中位数为7(6，8)分，康复出院时为2(2，3)分，末次随访为0(0，1.7)分，3个时间点的VAS评分组间差异有统计学意义(P<0.001)。术后膝关节屈曲挛缩角度平均为(30±13)°，康复出院时(8±5)°，末次随访为(7±10)°，3个时间点屈曲挛缩角度差异有统计学意义(F＝57.4，P<0.001)。术后膝关节活动范围为(56±21)°，康复出院时(99±11)°，末次随访(88±18)°，3个时间点膝关节活动范围差异有统计学意义(F＝53.8，P<0.001)。

结论

类风湿关节炎伴膝关节重度屈曲挛缩畸形的患者行人工膝关节置换术后，经过功能康复治疗后，可实现膝关节功能的改善。

关键词: 膝, 关节炎，类风湿, 挛缩, 关节成形术，置换，膝, 康复
Objective

To investigate the effect of knee rehabilitation training after total knee arthroplasty in rheumatoid arthritis knees with severe flexion contracture.

Methods

A retrospective analysis of 21 cases (36 knees) of rheumatoid arthritis with severe flexion contracture of knee joint over 60 degrees from June 2013 to September 2017 was carried out.The patients with other secondary knee osteoarthritis were excluded. Patients were performed rehabilitation treatments after total knee replacement. The visual analog pain score, flexion contracture and range of motion of knee were evaluated before and after operation, at discharge and at the last follow-up. The comparison between groups was tested by One-way ANOVA or Friedman test depending on their distribution.

Results

Fifteen (26 knees) of 21 patients were followed up for an average of (46±15) months. The median VAS score of knee joint was 7(6, 8) after operation, 2(2, 3) at discharge, and 0(0, 1.7) at the last follow-up. The difference of VAS at three time points was highly statistically significant(P<0.001). The average knee flexion contracture angle were (30±13)° after operation, (8±5)° at discharge and (7±10)° at the last follow-up. The analysis of variance showed that there were significant differences in the range of motion among time points (F=57.4, P<0.001). The average range of motion of the joint was (56±21)° after operation, (99±11)° at discharge and (88±18)°at the last follow-up. The analysis of variance showed that there was a significant difference in the range of motion between the four time points (F=53.8, P<0.001).

Conclusion

Series of rehabilitation measures following joint replacement can improve the knee function of rheumatoid arthritis patients with severe flexion contracture.

Key words: Knee, Arthritis, rheumatoid, Contracture, Arthroplasty, replacement, knee, Rehabilitation
图1 术后、出院时及末次随访的膝关节屈曲挛缩角度比较。膝关节过伸度数以负数表示；***-P<0.001；各时间点间两两比较，除出院时和末次随访差异无统计学意义外(P>0.05)，其他时间点差异有统计学意义(P<0.001)
图2 术后、出院时及末次随访的膝关节活动范围比较。各时间点两两比较，组间差异均有统计学意义(P<0.01)；**-P<0.01，***-P<0.001
[1]
Parvizi J, Lajam CM, Trousdale RT, et al. Total knee arthroplasty in young patients with juvenile rheumatoid arthritis[J]. J Bone Joint Surg Am, 2003, 85(6): 1090-1094.
[2]
Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet，2010，376(9746): 1094-108.
[3]
Morita Y, Ito H, Torii M, Hanai A, et al. Factors affecting walking ability in female patients with rheumatoid arthritis[J/OL]. PLoS One, 2018, 13(3): e0195059. doi: 10.1371/journal.pone.0195059.
[4]
Taheriazam A, Saeidinia A. Concurrent one-stage total knee and hip arthroplasty due to sequel of juvenile rheumatoid arthritis: a case report[J/OL]. Medicine (Baltimore), 2017, 96(46): e8779. doi: 10.1097/MD.0000000000008779.
[5]
Yan D, Yang J, Pei F. Total knee arthroplasty treatment of rheumatoid arthritis with severe versus moderate flexion contracture[J/OL]. J Orthop Surg Res，2013, 15(8): 41. doi: 10.1186/1749-799X-8-41.
[6]
Ishikawa H, Saura R, Ohno O, Hirohata K. Long－term results of posterior release surgery for severe flexion contracture of the knee in patients with rheumatoid arthritis[J]. Clin Orthop Relat Res. 1991，262: 242-247.
[7]
Lu H, Mow CS, Lin J. Total knee arthroplasty in the presence of severe flexion contracture: a report of 37 cases[J]. J Arthroplasty, 1999；14(7): 775-780.
[8]
Smiłowicz M, Jung L. Total knee arthroplasty in patients with severe deformities due to rheumatoid arthritis[J]．Orthop Traumatol Rehabil，2005, 7(6): 673-679.
[9]
Kumagai K, Harigane K, Kusayama Y, et al. Total knee arthroplasty improves both knee function and disease activity in patients with rheumatoid arthritis[J]. Mod Rheumatol, 2017, 27(5): 806-810.
[10]
Patel N, Gwam CU, Khlopas A, et al. Outcomes of cementless total knee arthroplasty in patients with rheumatoid arthritis[J]. Orthopedics, 2018, 41(2): 103-106.
[11]
Harb MA, Solow M, Newman JM, et al. Have the annual trends of total knee arthroplasty in rheumatoid arthritis patients changed？[J]. J Knee Surg, 2018, 31(9): 841-845.
[12]
Hou HB, Cao B, Shi SM, et al. Total knee arthroplasty for treatment of rheumatoid arthritis: a protocol for a systematic review of randomized controlled trial[J/OL]. Medicine (Baltimore), 2019, 98(30): e16558. 10.1097/MD.0000000000016558.
[13]
Cassidy JT. Juvenile rheumatoid arthritis. // Kelly WN, et al. Textbook of Rheumatology[M]. 3rd ed. Philidelphia: W．B. Saunders, 1989：1289-1311.
[14]
周程沛，周宗科，沈彬，等. 膝关节类风湿关节炎伴重度屈曲畸形患者关节置换术后的中长期随访[J/CD]. 中华关节外科杂志(电子版), 2012, 6(5); 689-694.
[15]
孙铁铮，吕厚山. 晚期类风湿关节炎合并膝关节强直或僵直畸形行人工膝关节置换术[J/CD]．中华关节外科杂志(电子版), 2011, 5(1): 3-9.
[16]
Massin P, Petit A, Odri G, et al. Total knee arthroplasty in patients with greater than 20 degrees flexion contracture[J]．Orthop Traumatol Surg Res, 2009, 95(4 Suppl 1): S7-S12.
[17]
Ravi B, Escott B, Shah PS, et al. A systematic review and meta-analysis comparing complications following total joint arthroplasty for rheumatoid arthritis versus for osteoarthritis[J]．Arthritis Rheum, 2012, 64(12): 3839-3849.
[18]
Hwang YS, Kyu PM, Kyung TK, et al. Total knee arthroplasty for severe flexion contracture in rheumatoid arthritis knees[J]. Knee Surg Relat Res, 2016, 28(4): 325-329.
[19]
Scuderi GR, Kochhar T. Management of flexion contracture in total knee arthroplasty[J]. J Arthroplasty, 2007, 22(4 Suppl 1): 20-24.
[20]
He Q, Xiao L, Ma JB, et al. A case report of successful treatment of 90° knee flexion contracture in a patient with adult-onset Still’s disease[J]. BMC Surg, 2016, 16(1): 7-7.
[21]
徐子涵，郭郡浩，杨路昕，等. 427例类风湿关节炎患者骨质疏松阳性率分析[J]. 中国骨质疏松杂志，2018, 24(12): 1573-1576, 1581.
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