本文選題：關節(jié)置換術　切入點：膝　出處：《北京協(xié)和醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的探討膝關節(jié)置換術后非感染性翻修手術的原因、治療方案以及功能恢復情況。方法檢索北京協(xié)和醫(yī)院骨科1991年5月至2016年11月期間所有入院行膝關節(jié)翻修的病例。排除重復住院、非膝關節(jié)翻修手術以及資料丟失病例,并進一步排除診斷膝關節(jié)感染,以及關節(jié)液或關節(jié)組織培養(yǎng)陰性,但關節(jié)液呈膿性并按膝關節(jié)感染處理的病例后,共獲得27例患者入院進行非感染性翻修手術。根據(jù)非感染性翻修的病因進行分組,總結(jié)各組翻修手術處理方式,分析翻修手術距離初次手術的間隔時間,對翻修前后關節(jié)力線及關節(jié)功能(HSS評分)進行評估。翻修手術與初次TKA的間隔時間主要進行描述分析;翻修前后的關節(jié)力線及關節(jié)功能KSS評分先行Kolmogorov-Smirnov檢驗,若數(shù)據(jù)服從正態(tài)分布,則行獨立樣本t檢驗分析。結(jié)果共篩選出27例(29膝)患者入院進行非感染性膝關節(jié)翻修術。翻修病因包括:假體無菌性松動14膝[48.3%(14/29)],其中6膝翻修部分置換了脛骨側(cè)假體,其余8膝均行全膝關節(jié)翻修術;膝關節(jié)僵直7膝[24.1%(7/29)],其中5膝行手術松解(關節(jié)鏡下粘連松解1膝),另有2膝行部分膝關節(jié)翻修術;初次置換術后有2膝[6.9%(2/29)]出現(xiàn)墊片脫位而行墊片置換手術;2膝[6.9%(2/29)]出現(xiàn)嚴重的墊片磨損,均行全膝關節(jié)翻修術;假體周圍骨折的2膝[6.9%(2/29)]行全膝關節(jié)翻修術;關節(jié)腔異物1膝[3.5%(1/29)],行膝關節(jié)后路異物取出術;髕骨外翻半脫位1膝[3.5%(1/29)],行髕骨外側(cè)支持帶松解、內(nèi)側(cè)緊縮術。66.7%(8/12)的膝關節(jié)力線不良在翻修術后得到恢復,術后平均糾正7.9± 1.7度,差異具有統(tǒng)計學意義(t=4.612,P0.05),膝關節(jié)功能術后HSS評分平均為(81.1 ±7.4)分,較術前(54.5± 17.1)分改善明顯(t=-4.520,P=0.001)。結(jié)論導致膝關節(jié)無菌性翻修的病因是綜合性的,其中主要原因是初次膝關節(jié)置換術后假體無菌性松動(48.3%)、關節(jié)僵直(24.1%)。翻修術中面對嚴重的骨缺損,使用墊塊修補缺損并加用延長桿是保證假體穩(wěn)定性的重要手術策略。針對初次全膝關節(jié)置換術后出現(xiàn)假體無菌性松動、關節(jié)僵直、假體周圍骨折等問題,全膝關節(jié)置換翻修術能夠有效地恢復關節(jié)力線及膝關節(jié)功能。
[Abstract]:Objective to investigate the causes of non-infectious revision surgery after knee arthroplasty. Methods all patients admitted to the Department of Orthopaedics of Peking Union Union Hospital from May 1991 to November 2016 were searched for knee revision, excluding repeated hospitalization, non-knee revision surgery and data loss. The diagnosis of knee joint infection and the negative tissue culture of the joint fluid or joint were further excluded, but the joint fluid was purulent and treated according to the knee joint infection. A total of 27 patients were admitted to hospital for non-infectious revision surgery. According to the etiology of non-infectious revision, the treatment methods were summarized, and the interval between the revision operation and the first operation was analyzed. The interval between the revision operation and the initial TKA was mainly described and analyzed. The Kolmogorov-Smirnov test was performed before and after revision of the joint force line and the KSS score of the joint function. If the data is normally distributed, Results A total of 27 patients (29 knees) were selected for non-infectious knee revision. The causes of revision included aseptic loosening of 14 knees (48.3% 14 / 29), in which 6 knees were partially replaced with lateral tibial prosthesis. Total knee arthroplasty was performed in the remaining 8 knees, knee stiffness was achieved in 7 knees [24. 1 / 29 / 29], among which 5 knees underwent surgical release (1 knee arthroscopic adhesion release, 2 knee partial knee revision surgery). After the first replacement, 2 knees [6.9 / 29] had dislocation of gasket, 2 knees (6.910 / 29) had severe wear of gasket, 2 knees of periprosthetic fracture (6.910 / 29) were treated with total knee arthroplasty, 2 knees with periprosthetic fracture were treated with total knee arthroplasty, and 2 knees (6.920 / 29) with periprosthetic fracture were treated with total knee arthroplasty. Foreign body in articular cavity (1 knee [3. 5 / 1 / 29], posterior approach of knee joint foreign body extraction, patellar valgus subluxation 1 knee [3. 5 / 1 / 29], lateral patellar retinaculum loosening, medial contraction .66. 7% / 8 / 12) recovery after revision, average correction of 7. 9 鹵1. 7 degrees after operation. The difference was statistically significant (P 0.05). The average score of HSS after knee joint operation was 81.1 鹵7.4, which was significantly better than that before operation (54.5 鹵17.1). Conclusion the cause of aseptic revision of knee joint is comprehensive. The main causes are aseptic loosening of the prosthesis after the first knee arthroplasty, 48.3% of the prosthetic loosening and 24.1% stiffness of the joint. Serious bone defects were encountered during the revision operation. Repair of defects with pad and extension rod is an important operative strategy to ensure the stability of prosthesis. After the initial total knee arthroplasty, the prosthesis becomes aseptic loosening, joint stiffness, fracture around the prosthesis, etc. Total knee arthroplasty and revision can effectively restore the joint force line and knee joint function.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

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