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全膝关节置换治疗类风湿性关节炎临床分析作者：周健胡孔足
来源：《中国医药科学》2012年第04期
[摘要] 目的探讨膝关节全膝关节置换治疗类风湿性关节炎的临床效果。方法对12例类风湿性关节炎患者（16膝）进行全膝关节置换。根据软组织平衡情况采用后稳定型膝关节非限
制性假体（12膝）或者限制性假体（4膝），记录骨缺损、手术时间、出血量、关节稳定性、髌骨轨迹和术后功能恢复情况。结果所有病例均顺利度过围手术期，手术时间（125±15）min，术中出血量（150±25）mL，术后出血量（650±75）mL。所有关节获得良好的稳定性，平均活动度为（120±25） °。经过3～42个月随访，HSS评分由手术前平均25分提高至手术后平均95分，无一例感染及深静脉血栓。结论类风湿性关节炎病理改变复杂，手术的难度大，需要很好的软组织平衡技术，韧带损伤严重者需要采用限制性假体才能取得满意的疗效。
[关键词] 类风湿性关节炎；膝关节；人工关节
[中图分类号] R687.4 [文献标识码] A [文章编号] 2095-0616（2012）04-19-02
Clinical analysis of total knee arthroplasty for rheumatoid arthritis
ZHOU Jian HU Kongzu
Department of Orthopaedics,the 1st Affiliated Hospital of Anhui Medical University,Hefei 230022,China
[Abstract] Objective To study the effect of total knee arthroplasty for rheumatoid arthritis. Methods 12 cases (16 knees) with late stage rheumatoid arthritis were undergone TKA. The prostheses were selected according to soft tissue balance. 12 knees were performed TKA with nonconstrained prostheses,while 4 with constrained prostheses. Bone defect,operation time,blood loss,joint stability,patellar tract and functional recovery were restored. Results All cases went well during perioperative period. The operation time was (125±15)mins. The blood loss was (150±25)mL intraoperatively,and (650±75)mL postoperatively. All cases restored joint stability. The rang of motion was (120±25)°. After 3~42 months’ follow-up, HSS scores were improved from 25 preoperatively,and 95 postoperatively. No infection and deep vain thrombosis were found. Conclusion Pathology change of knee rheumatoid arthritis is complex,so the good operative skills,especially soft tissue balance are demanded. Constrained prosthesis is required for those with ligament compromises.
[Key words] Rheumatoid arthritis;Knee;Arthroplasty
类风湿性关节炎是一种严重的全身免疫系统疾病，当累及到髋、膝关节后，可导致严重的关节畸形、疼痛、关节功能丧失，最终需要进行人工关节置换术。近年来，笔者所在医院逐渐