發(fā)布時(shí)間：2018-05-10 23:07

  本文選題：單髁膝關(guān)節(jié)置換術(shù) + 假體��； 參考：《天津醫(yī)科大學(xué)》2015年碩士論文

【摘要】：單髁膝關(guān)節(jié)置換術(shù)(unicompartmental knee arthroplasty,UKA)是一種治療膝關(guān)節(jié)炎的常見的手術(shù)方式,通過表面置換病變間室,達(dá)到減輕疼痛程度、恢復(fù)到接近膝關(guān)節(jié)正常生理功能的目的。具有手術(shù)創(chuàng)傷小,骨量丟失少,疼痛輕的優(yōu)點(diǎn),術(shù)后恢復(fù)快,術(shù)后本體感覺接近生理狀態(tài),易翻修等優(yōu)點(diǎn),是治療骨性關(guān)節(jié)炎的常見操作。全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)這種手術(shù)方法在臨床上使用已經(jīng)非常廣泛,經(jīng)常見于各類文獻(xiàn)報(bào)道,且技術(shù)成熟,被公認(rèn)為是嚴(yán)重膝關(guān)節(jié)病變治療的金標(biāo)準(zhǔn),手術(shù)療效顯著,但缺點(diǎn)是創(chuàng)傷較大,術(shù)后病人康復(fù)時(shí)間較長(zhǎng)。近年來,假體設(shè)計(jì)日趨成熟,同時(shí)手術(shù)器械不斷的翻新,在合理的掌握手術(shù)操作技術(shù)的情況下,手術(shù)療效的大幅提高使得UKA在膝骨關(guān)節(jié)炎的治療中已經(jīng)取得了相當(dāng)驚人的進(jìn)步。把握好手術(shù)適應(yīng)癥,手術(shù)效果是令人滿意的,患者滿意度明顯提高。同時(shí)UKA保存了骨量,基本保持正常的解剖關(guān)系,術(shù)后并發(fā)癥少、本體感覺好,具有很好的臨床應(yīng)用前景。我院于2013年開展此手術(shù),目前手術(shù)例數(shù)仍較少,為12例。通過本文的分析研究,明確這種手術(shù)方式在單間室病變的治療過程中所體現(xiàn)的安全性、創(chuàng)傷量及臨床治療效果等,為今后此類患者的治療做出指導(dǎo)方向。目的通過對(duì)已經(jīng)完成的12例UKA和選取相同年齡段、病變程度相似的12例TKA進(jìn)行分析,研究?jī)煞N手術(shù)方式在術(shù)后早期的治療效果,將單間室病變的膝骨關(guān)節(jié)炎術(shù)后的安全性、創(chuàng)傷量及臨床療效進(jìn)行對(duì)比分析,觀察此類病變部位局限于單一間室的病人是否行UKA更具有優(yōu)勢(shì)。方法將2013年4月至2015年1月間的住院患者24例,分為兩組,其中進(jìn)行UKA的12例患者為UKA組,進(jìn)行TKA12例的患者為TKA組,UKA組年齡51-87歲,男性患者6例,女性患者6例。TKA組平均年齡53-80歲,男性患者6例,女性患者6例。上述24例患者均為單間室病變的膝骨關(guān)節(jié)炎患者。本研究單間室病變患者的診斷標(biāo)準(zhǔn)是患處僅局限于內(nèi)側(cè)間室;小于5°的固定屈曲畸形;膝關(guān)節(jié)主動(dòng)活動(dòng)度至少90°;以及內(nèi)翻畸形小于15°。兩組患者身體情況在正常范圍內(nèi),血糖和血壓均得到了有效控制。且均無過度肥胖,無炎癥性關(guān)節(jié)炎和多關(guān)節(jié)疾病,無明顯靜息痛�；颊咝g(shù)前膝關(guān)節(jié)屈曲至少90°,關(guān)節(jié)活動(dòng)受限為內(nèi)翻15°,病變主要局限于膝內(nèi)側(cè)間室。術(shù)后第一天、第三天、第七天、術(shù)后一個(gè)月、術(shù)后三個(gè)月進(jìn)行分析和隨訪,出院后采用門診和給患者或家屬打電話等隨訪方式,采集手術(shù)操作后的影像學(xué)資料,查看患者是否發(fā)生切口感染,假體松動(dòng),下沉或位于不良位置,聚乙烯襯墊脫位,假體斷裂、骨折,下肢深靜脈血栓形成和肺栓塞,膝關(guān)節(jié)對(duì)側(cè)脛骨和髕股關(guān)節(jié)骨性關(guān)節(jié)炎的進(jìn)展有無并發(fā)癥。入院當(dāng)天和術(shù)后第三天、第七天進(jìn)行血常規(guī),C反應(yīng)蛋白(C-reactionprotein,CRP)和血沉(Equivalent Series Resistance,ESR)檢查,比較兩種術(shù)式在住院時(shí)間、血常規(guī)和CRP、ESR變化、出血量和血紅蛋白較前變化值、疼痛評(píng)分、膝關(guān)節(jié)功能評(píng)分、HSS評(píng)分對(duì)比、膝關(guān)節(jié)內(nèi)翻畸形矯正對(duì)比、體重、術(shù)中出血量的比較。采用SPSS19.0軟件對(duì)以上數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,對(duì)兩組數(shù)據(jù)進(jìn)行t檢驗(yàn),檢驗(yàn)差異是否具有統(tǒng)計(jì)學(xué)意義。了解膝關(guān)節(jié)骨性關(guān)節(jié)炎的治療UKA是否可以表現(xiàn)出比TKA術(shù)后恢復(fù)快、創(chuàng)傷小的優(yōu)點(diǎn)。結(jié)果單髁關(guān)節(jié)置換術(shù)可應(yīng)用于單間室病變的治療,這一點(diǎn)與TKA相似。從本研究可以得出結(jié)論,UKA改變了膝關(guān)節(jié)髕骨運(yùn)動(dòng)軌跡,使膝關(guān)節(jié)更有力,活動(dòng)度更好�；颊咛弁锤杏X可基本達(dá)到無痛,優(yōu)良率可達(dá)100%,步態(tài)接近正常,行走可達(dá)2500-5000米且無需借助支具。UKA組術(shù)后一個(gè)月和術(shù)后三個(gè)月隨訪期間所進(jìn)行的HSS評(píng)分高于TKA組。平均住院日方面UKA組平均住院日為5.73日,TKA組平均住院日為7.91日,UKA組較TKA組縮短,且病人住院費(fèi)用也低于TKA組。術(shù)后恢復(fù)時(shí)間短,膝關(guān)節(jié)靈活度更高,疼痛緩解優(yōu)良率高。UKA和TKA兩組患者膝關(guān)節(jié)內(nèi)翻畸形矯正對(duì)比、體重、術(shù)中出血量的比較顯示UKA組內(nèi)翻角(術(shù)前)平均為10.9+0.16°,內(nèi)翻角(術(shù)后)3.3+0.33°,內(nèi)翻角(矯正)6.7+0.67°,體重平均為71.2+0.67KG,術(shù)中出血量平均為115.8+0.83m L,與TKA相比較,UKA的優(yōu)勢(shì)在于術(shù)中出血少,術(shù)后引流量低,血紅蛋白較前下降值低,提示恢復(fù)迅速。缺點(diǎn)是手術(shù)適應(yīng)癥較窄,內(nèi)翻角矯正度數(shù)不如TKA,本研究中兩組患者未發(fā)生并發(fā)癥。UKA術(shù)后早期治療效果值得肯定。結(jié)論UKA是有效的單間室病變的治療方式,其優(yōu)點(diǎn)是病人康復(fù)快、創(chuàng)傷小。與TKA比較該手術(shù)住院天數(shù)少、出血量少、術(shù)后并發(fā)癥少。在術(shù)后減輕疼痛程度方面與TKA相比,UKA術(shù)后療效好,患者滿意度高。
[Abstract]:Single condylar knee arthroplasty (unicompartmental knee arthroplasty, UKA) is a common surgical method for the treatment of knee arthritis. Through the surface replacement of the interventricular disease, the degree of pain can be reduced and the normal physiological function of the knee joint is restored. It has the advantages of small trauma, less bone loss and light pain, and quick recovery after operation. It is a common operation for the treatment of osteoarthritis (total knee arthroplasty, TKA), which is widely used in clinical literature and is often reported in various literature, and is widely recognized as a gold mark for the treatment of serious knee joint lesions. In recent years, the prosthesis design is becoming mature, and the surgical instruments are constantly refurbished. In the case of reasonable mastery of the surgical technique, the significant improvement of the surgical effect has made UKA considerable progress in the treatment of knee osteoarthritis. The operation effect is satisfactory and the patient satisfaction is obviously improved. At the same time, the UKA preserves the bone quantity, keeps the normal anatomical relationship, the postoperative complications are few, the proprioception is good, and it has a good clinical application prospect. In 2013, this hand operation was carried out in our hospital, and the number of cases is still less, 12 cases through this article. In order to provide guidance for the treatment of this kind of patients in the future, 12 cases of UKA and 12 cases with similar pathological changes were analyzed and two kinds of hands were studied by analyzing the safety, the amount of trauma and the effect of clinical treatment in the treatment of single compartment disease. In the early postoperative treatment, the safety, the amount of trauma and the clinical effect of the knee osteoarthritis after the single compartment disease were compared and analyzed, and it was observed whether the patients who were confined to the single compartment were superior to UKA. Methods 24 cases of hospitalized patients from April 2013 to January 2015 were divided into two groups. The 12 patients with UKA were group UKA, TKA12 patients were group TKA, group UKA was 51-87 years old, 6 male patients, 6 female patients with the average age of 53-80 years, 6 male patients and 6 female patients. The above 24 patients were all patients with single compartment lesions of the knee osteoarthritis. The diagnostic criteria for the patients with single ventricular lesions were the affected area. It was limited to the medial compartment; a fixed flexion deformity less than 5 degrees; the active activity of the knee was at least 90 degrees; and the varus deformity was less than 15 degrees. The body conditions in the two groups were effectively controlled within the normal range. No excessive obesity, no inflammatory arthritis and multiple joint diseases, and no obvious resting pain. The joint flexion was at least 90 degrees and the joint activity was limited to varus 15 degrees. The lesion was mainly confined to the medial compartment of the knee. The first day, third days, seventh days after the operation, one month after the operation, and three months after the operation were analyzed and followed up. After the discharge, the outpatient and the patients or family members were called, and the imaging data after the operation were collected to check the patient's patient. Whether there were incisional infection, prosthesis loosening, sink or location, polyethylene liner dislocation, fracture of prosthesis, fracture, deep vein thrombosis of lower extremity and pulmonary embolism, the progress of the knee joint to the tibia and patellar joint osteoarthritis, the day of admission and third days after the operation, seventh days of blood routine, C reactive protein (C- Reactionprotein, CRP) and erythrocyte sedimentation rate (Equivalent Series Resistance, ESR), compared two kinds of surgical procedures in hospital time, blood routine and CRP, ESR change, bleeding volume and hemoglobin earlier change value, pain score, knee joint function score, HSS score comparison, knee arthrosis correction contrast, weight, intraoperative bleeding volume comparison. SPSS19. .0 software carries out statistical analysis of the above data and t tests of two groups of data to test whether the difference is statistically significant. To understand whether the treatment of osteoarthritis of the knee can show faster recovery and less trauma than TKA. Results single condylar arthroplasty should be used for the treatment of single compartment lesions, which is associated with TKA. It can be concluded from this study that UKA changes the track of the knee joint and makes the knee more powerful and more active. The pain sensation of the patient can be almost painless, the rate of good is up to 100%, the gait is close to normal, the walk is 2500-5000 meters, and it does not need the support of group.UKA after one month after the operation and the three month follow-up period after the operation. The HSS score was higher than that of the TKA group. The average hospitalization day in the group UKA was 5.73 days, the average hospitalization day in the group TKA was 7.91 days, the UKA group was shorter than the TKA group, and the hospitalization cost of the patients was lower than that of the TKA group. The postoperative recovery time was shorter, the flexibility of the knee joint was higher, the pain relief rate was higher in.UKA and TKA two groups of patients with knee varus deformity correction comparison. Heavy, intraoperative bleeding volume compared to the UKA group of varus angle (preoperative) average of 10.9+0.16 degrees, varus angle (post operation) 3.3+0.33 degrees, varus angle (Jiao Zheng) 6.7+0.67 degrees, average weight 71.2+0.67KG, intraoperative bleeding average of 115.8+0.83m L, compared with TKA, the advantage of UKA is less bleeding in the operation, lower flow rate after operation, lower hemoglobin than the former. The shortcoming is the rapid recovery. The shortcoming is that the operation is narrower and the correction degree of the varus angle is not as good as TKA. In this study, the early treatment effect of the two groups of patients without complications after.UKA is worth affirming. Conclusion UKA is an effective method for the treatment of the single compartment disease, its advantage is that the patient is quickly recovered and the wound is small. The number of hospitalized days is less than that of TKA, bleeding is less, bleeding is less. Less pain and less postoperative complications. Compared with TKA, postoperative pain relief is better than UKA.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

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8 潘l，

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