同期双侧人工全膝关节表面置换修复类风湿膝关节炎

摘要

BACKGROUND:Total knee arthroplasty is the major treatment of rheumatoid arthritis at advanced stage. Most of scholars prefer the staging replacement and adopt semi-restricting prosthesis to increase the stability of prosthesis. n OBJECTIVE:To investigate the clinical effect of synchronous total knee arthroplasty for treatment of bilateral knee rheumatoid arthritis. n METHODS:From June 2011 to December 2013, 27 patients of knee rheumatoid arthritis were recruited from the First Department of Orthopedics at the Third Hospital of Chinese PLA, and were treated with total knee arthroplasty at the bilateral sides over the same period. According to the symptoms, functional recovery and imaging evaluation, postoperative effect was assessed. The involved patients were folowed up at 2 weeks, 1 month, 3 months, 6 months after surgery and afterwards once per year. The relief of pain symptoms, recovery of joint function, X-ray examination, loosening and sink of the prosthesis were observed during folow-ups. n RESULTS AND CONCLUSION:Al the patients were folowed up over a period of 9-26 months. After operation the pain disappeared, preoperative flexion and varus valgus deformity were corrected, limb walking function recovered wel. The Hospital for Special Surgery scores was average 31.8 points before operation and increased to average 82.7 points after operation. There was no infection, lower limb deep vein thrombosis, loosening and sink of the prosthesis. Simultaneous total knee arthroplasty at the bilateral sides is a safe, effective operation method in the treatment of bilateral knee rheumatoid arthritis, with short recovery time and hospitalization period, it can avoid psychological and economic impact of the two single knee replacement operations to the patients.%背景：人工膝关节置换是治疗晚期类风湿关节炎的主要手段，目前多数学者采用分期置换，且多数医生为增加术后假体稳定性，采用半限制性假体。n　　目的：探讨双膝类风湿关节炎患者行同期双侧全膝关节表面置换的修复效果。n　　方法：选取2011年6月至2013年12月解放军第三医院骨一科收治的27例双膝类风湿关节炎患者，采用人工全膝关节表面置换，均为同期双侧。根据症状、功能恢复及影像学检查评价置换后效果。随访时间为置换后2周、1个月、3个月、6个月，超过6个月1年1次，内容包括疼痛症状的消除情况、关节功能恢复情况， X射线片表现，假体位置有无松动、下沉等情况。n　　结果与结论：全组病例均获得随访，时间9-26个月。置换后疼痛消失，置换前屈曲内翻、外翻畸形纠正，患肢行走功能恢复良好。按美国特种外科医院评分标准，由置换前平均31.8分提高到置换后平均82.7分。全组无感染、下肢深静脉血栓、假体松动及下沉发生。提示同期双侧人工全膝关节表面置换是修复双膝类风湿关节炎安全、有效的方法，康复时间及住院周期短，可避免两次单膝置换给患者带来的心理及经济影响。