高屈曲假體加延長桿在晚期類風濕關(guān)節(jié)炎伴重度膝外翻畸形和嚴重骨質(zhì)疏松患者中的臨床療效研究
發(fā)布時間：2018-10-07 18:46
【摘要】：目的探討晚期類風濕關(guān)節(jié)炎(RA)伴重度膝外翻畸形和嚴重骨質(zhì)疏松患者膝關(guān)節(jié)置換術(shù)假體選擇及臨床效果。方法選取2008—2014年蘭州軍區(qū)總醫(yī)院全軍骨科中心關(guān)節(jié)外科采用髕旁內(nèi)側(cè)入路、常規(guī)截骨加單純外側(cè)軟組織松解方法治療晚期RA伴重度膝外翻畸形和嚴重骨質(zhì)疏松患者27例(32膝)。18例(20膝)采用不保留后十字韌帶型后穩(wěn)定型常規(guī)假體:Nex Gen HF-Flex常規(guī)膝(后穩(wěn)定型組),9例(12膝)采用Nex Gen HF-Flex常規(guī)膝+延長桿(后穩(wěn)定型+延長桿組)。采用術(shù)前及末次隨訪時膝關(guān)節(jié)屈曲攣縮、關(guān)節(jié)活動度、股脛角等評價手術(shù)效果。結(jié)果手術(shù)時間60~120 min,平均75 min。隨訪時間2.0~7.5年,平均4.9年。后穩(wěn)定型組和后穩(wěn)定型+延長桿組末次隨訪時膝關(guān)節(jié)屈曲攣縮較術(shù)前減少、關(guān)節(jié)活動度較術(shù)前提高(P0.05)。術(shù)前及末次隨訪時,后穩(wěn)定型組與后穩(wěn)定型+延長桿組膝關(guān)節(jié)屈曲攣縮、關(guān)節(jié)活動度比較,差異均無統(tǒng)計學意義(P0.05)。所有患者外翻畸形得到糾正,后穩(wěn)定型組和后穩(wěn)定型+延長桿組末次隨訪時股脛角較術(shù)前減小(P0.05)。術(shù)前及末次隨訪時,后穩(wěn)定型組與后穩(wěn)定型+延長桿組股脛角比較,差異均無統(tǒng)計學意義(P0.05)。術(shù)后3例(3膝)有膝關(guān)節(jié)外側(cè)不穩(wěn)癥狀,給予膝關(guān)節(jié)支具保護;2例(3膝)術(shù)后1個月出現(xiàn)下肢靜脈血栓,給予放置下腔靜脈濾網(wǎng);1例(1膝)術(shù)后發(fā)生腓總神經(jīng)麻痹。其余患者隨訪期間未發(fā)生假體感染、假體周圍骨折、異位骨化、假體松動及外翻等術(shù)后并發(fā)癥。結(jié)論對晚期RA伴重度膝外翻畸形和嚴重骨質(zhì)疏松患者在假體選擇方面,后穩(wěn)定型假體與后穩(wěn)定型假體+延長桿在糾正外翻屈曲畸形、關(guān)節(jié)活動度和股脛角療效等方面,未見差異,所有患者近期療效滿意,但對于此類患者而言,后穩(wěn)定型假體+延長桿組穩(wěn)定性較好,受RA病程進展影響較低。
[Abstract]:Objective to investigate the prosthesis selection and clinical effect of knee arthroplasty in patients with advanced rheumatoid arthritis (RA) with severe valgus deformity and severe osteoporosis. Methods from 2008 to 2014, the medial parrapatellar approach was used in the joint surgery of the Department of Orthopaedic, Lanzhou military region General Hospital. 27 cases (32 knees) and 18 cases (20 knees) of advanced RA with severe valgus deformity and severe osteoporosis were treated by routine osteotomy combined with simple lateral soft tissue release. Nine patients (12 knees) with knee gauge (posterior stable type) were treated with Nex Gen HF-Flex routine knee lengthening (posterior stable extension rod group). Knee flexion contracture, joint motion and femoral tibial angle were evaluated before and at the last follow-up. Results the average operation time was 75 min. (60 min,). The follow-up time ranged from 2.0 to 7.5 years (average 4.9 years). At the last follow-up, the flexion contracture of knee joint in the posterior stable type group and the posterior stable extension rod group was decreased, and the range of motion of the knee joint was higher than that before the operation (P0.05). Before and at the last follow-up, there was no significant difference in flexion contracture and joint motion between the posterior stable type group and the posterior stable extension rod group (P0.05). The valgus deformity was corrected in all patients, and the tibial angle was decreased in the posterior stable type group and the posterior stable extension rod group at the last follow-up (P0.05). There was no significant difference in tibial angle between the posterior stable type group and the posterior stable extension rod group before and after the last follow-up (P0.05). There were 3 cases (3 knees) with lateral instability of knee joint after operation, 2 cases (3 knees) had lower limb venous thrombosis 1 month after operation, 1 case (1 knee) had common peroneal nerve palsy after operation. There were no postoperative complications such as prosthetic infection, periprosthetic fracture, ectopic ossification, prosthesis loosening and valgus. Conclusion for the patients with advanced RA with severe valgus deformity and severe osteoporosis, posterior stable prosthesis and posterior stable prosthesis lengthening rod can correct valgus flexion deformity, joint motion and tibial angle, etc. There was no difference. All the patients had satisfactory short-term curative effect, but for these patients, the stability of post stable prosthesis lengthening rod group was better, and was less affected by the progression of RA.
【作者單位】： 蘭州軍區(qū)總醫(yī)院全軍骨科中心關(guān)節(jié)外科;第四軍醫(yī)大學西京醫(yī)院老年病科;寧夏醫(yī)科大學研究生院;
【基金】：國家自然科學基金資助項目(81371983) 甘肅省自然科學基金資助項目(1606RJZA208) 甘肅省科技支撐計劃資助項目(S04671) 甘肅省青年科技基金資助項目(1606RJYA300)
【分類號】：R580;R687.4
[Abstract]:Objective to investigate the prosthesis selection and clinical effect of knee arthroplasty in patients with advanced rheumatoid arthritis (RA) with severe valgus deformity and severe osteoporosis. Methods from 2008 to 2014, the medial parrapatellar approach was used in the joint surgery of the Department of Orthopaedic, Lanzhou military region General Hospital. 27 cases (32 knees) and 18 cases (20 knees) of advanced RA with severe valgus deformity and severe osteoporosis were treated by routine osteotomy combined with simple lateral soft tissue release. Nine patients (12 knees) with knee gauge (posterior stable type) were treated with Nex Gen HF-Flex routine knee lengthening (posterior stable extension rod group). Knee flexion contracture, joint motion and femoral tibial angle were evaluated before and at the last follow-up. Results the average operation time was 75 min. (60 min,). The follow-up time ranged from 2.0 to 7.5 years (average 4.9 years). At the last follow-up, the flexion contracture of knee joint in the posterior stable type group and the posterior stable extension rod group was decreased, and the range of motion of the knee joint was higher than that before the operation (P0.05). Before and at the last follow-up, there was no significant difference in flexion contracture and joint motion between the posterior stable type group and the posterior stable extension rod group (P0.05). The valgus deformity was corrected in all patients, and the tibial angle was decreased in the posterior stable type group and the posterior stable extension rod group at the last follow-up (P0.05). There was no significant difference in tibial angle between the posterior stable type group and the posterior stable extension rod group before and after the last follow-up (P0.05). There were 3 cases (3 knees) with lateral instability of knee joint after operation, 2 cases (3 knees) had lower limb venous thrombosis 1 month after operation, 1 case (1 knee) had common peroneal nerve palsy after operation. There were no postoperative complications such as prosthetic infection, periprosthetic fracture, ectopic ossification, prosthesis loosening and valgus. Conclusion for the patients with advanced RA with severe valgus deformity and severe osteoporosis, posterior stable prosthesis and posterior stable prosthesis lengthening rod can correct valgus flexion deformity, joint motion and tibial angle, etc. There was no difference. All the patients had satisfactory short-term curative effect, but for these patients, the stability of post stable prosthesis lengthening rod group was better, and was less affected by the progression of RA.
【作者單位】： 蘭州軍區(qū)總醫(yī)院全軍骨科中心關(guān)節(jié)外科;第四軍醫(yī)大學西京醫(yī)院老年病科;寧夏醫(yī)科大學研究生院;
【基金】：國家自然科學基金資助項目(81371983) 甘肅省自然科學基金資助項目(1606RJZA208) 甘肅省科技支撐計劃資助項目(S04671) 甘肅省青年科技基金資助項目(1606RJYA300)
【分類號】：R580;R687.4
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