本文選題：肥胖 + 延長柄　； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2015年碩士論文

【摘要】：背景目前全膝關(guān)節(jié)置換術(shù)(total knee arthrolasty,TKA)已經(jīng)成為治療終末期膝關(guān)節(jié)疾病的主要方法,能夠有效緩解疼痛,改善膝關(guān)節(jié)功能,提高生活質(zhì)量。而隨著肥胖人群的顯著增加,以及我國的人口老齡化趨勢(shì)日益嚴(yán)峻,TKA正面臨越來越多的肥胖老齡患者。但肥胖被認(rèn)為是膝關(guān)節(jié)置換失敗的主要危險(xiǎn)因素之一,大量相關(guān)文獻(xiàn)報(bào)道肥胖患者TKA術(shù)后假體無菌性松動(dòng)、感染、手術(shù)切口并發(fā)癥和關(guān)節(jié)翻修率遠(yuǎn)高于非肥胖患者。關(guān)節(jié)外科醫(yī)師對(duì)肥胖在TKA術(shù)后的影響以及手術(shù)方式的選擇進(jìn)行了很多的研究。本研究應(yīng)用普通假體結(jié)合脛骨延長柄行TKA治療重度肥胖患者膝關(guān)節(jié)骨性關(guān)節(jié)炎,探討并評(píng)價(jià)其臨床療效。目的探討脛骨延長柄在重度肥胖患者全膝關(guān)節(jié)置換中的臨床應(yīng)用并評(píng)價(jià)其臨床療效。方法回顧性分析我院2009年5月至2012年5月期間19例(23膝)終末期骨性關(guān)節(jié)炎在初次TKA中應(yīng)用脛骨延長柄的臨床病例資料,其中男性4例,女性15例,平均年齡65.2歲(53-78歲),單側(cè)置換15例(左側(cè)9例,右側(cè)6例),雙側(cè)置換4例,所有患者均為重度肥胖,BMI均值為37.77±1.27kg/m2。應(yīng)用美國膝關(guān)節(jié)學(xué)會(huì)評(píng)分(knee society score, KSS)系統(tǒng)和WOMAC評(píng)分對(duì)手術(shù)前后膝關(guān)節(jié)進(jìn)行評(píng)估,各組數(shù)據(jù)采用SPSS 17.0進(jìn)行統(tǒng)計(jì)學(xué)分析,以評(píng)價(jià)臨床療效及假體生存率。結(jié)果17例(21膝)獲得隨訪,2例(2膝)失訪,平均隨訪44月(27-65月)。術(shù)后有1例(1膝)出現(xiàn)手術(shù)切口脂肪液化,無一例出現(xiàn)感染、假體松動(dòng)、VTE等并發(fā)癥。術(shù)后下肢力線良好,關(guān)節(jié)穩(wěn)定,髕骨軌跡良好,無腓總神經(jīng)損傷、髕腱撕裂等術(shù)中并發(fā)癥。末次隨訪時(shí)患者臨床及影像學(xué)結(jié)果顯示無一例出現(xiàn)假體周圍骨折、感染、無菌性松動(dòng)、假體高懸、髕骨骨折等并發(fā)癥,也未發(fā)現(xiàn)明顯的骨質(zhì)溶解。膝評(píng)分從術(shù)前20.9±4.5分提高到術(shù)后末次90.7±3.5分,膝功能評(píng)分從術(shù)前25.7±4.7分提高到術(shù)后末次87.0±3.7分,術(shù)前WOMAC評(píng)分為157.1±20.0分,術(shù)后末次WOMAC評(píng)分改善為42.5±18.6分,其中輕度18膝(85.7%),中度3膝(14.3%),重度0膝(0%),差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論重度肥胖的膝關(guān)節(jié)骨性關(guān)節(jié)炎患者接受初次TKA治療時(shí),應(yīng)用脛骨延長柄可以傳導(dǎo)并分散脛骨平臺(tái)應(yīng)力,增強(qiáng)假體穩(wěn)定性,降低假體翻修率與術(shù)后并發(fā)癥,可獲得良好的臨床療效。
[Abstract]:Background Total knee arthroplasty has become the main method for the treatment of end-stage knee diseases, which can effectively relieve pain, improve knee function and improve the quality of life. With the significant increase of obese population and the aging trend of population in China, TKA is facing more and more obese elderly patients. However, obesity is considered to be one of the main risk factors for the failure of knee replacement. A large number of related literature reported that the rate of prosthetic loosening, infection, surgical incision complications and joint revision after TKA in obese patients is much higher than that in non-obese patients. Joint surgeons have done a lot of research on the influence of obesity after TKA and the choice of surgical methods. In this study, TKA was used to treat knee osteoarthritis in patients with severe obesity. Objective to investigate the clinical application of tibial lengthening handle in total knee arthroplasty in patients with severe obesity. Methods the clinical data of 19 patients with end-stage osteoarthritis treated with tibial lengthening in primary TKA from May 2009 to May 2012 were retrospectively analyzed, including 4 males and 15 females. The mean age was 65.2 years old and 53-78 years old, 15 cases were unilateral replacement (9 cases on left side, 6 cases on right side and 4 cases on bilateral replacement). The mean BMI of all patients was 37.77 鹵1.27 kg / m ~ (2). The knee joint before and after operation was evaluated by the American knee Society society score, KSS) system and WOMAC score. The data of each group were analyzed statistically by SPSS 17.0 to evaluate the clinical effect and the survival rate of prosthesis. Results 17 cases (21 knees) were followed-up 2 cases (2 knees) lost, the average follow-up time was 44 months, 27 to 65 months. After operation, 1 case (1 knee) had incision fat liquefaction, no infection, VTE and other complications. Postoperative lower limb force line was good, joint was stable, patella track was good, no common peroneal nerve injury, patellar tendon laceration and other intraoperative complications. The clinical and imaging results of the patients at the last follow-up showed that there were no complications such as periprosthetic fracture, infection, aseptic loosening, high suspension of prosthesis, patellar fracture, and no obvious osteolysis. The knee score increased from 20.9 鹵4.5 before operation to 90.7 鹵3.5 at the last postoperative time, the knee function score increased from 25.7 鹵4.7 to 87.0 鹵3.7, the WOMAC score before operation was 157.1 鹵20.0, and the last WOMAC score improved 42.5 鹵18.6 after operation. The difference was statistically significant in 18 knees (85.7%), 3 knees (14.3%) and 0 knees (severe 0). The difference was statistically significant (P 0.05). Conclusion the tibia lengthening handle can conduct and disperse the stress of the tibial plateau, enhance the stability of the prosthesis, reduce the rate of revision and postoperative complications when the patients with severe obesity osteoarthritis of the knee are treated with TKA for the first time. Good clinical effect can be obtained.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.42

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 林劍浩;呂厚山;寇伯龍;袁燕林;鐘群杰;;全膝關(guān)節(jié)初次置換術(shù)失敗行翻修手術(shù)的必要性[J];中華關(guān)節(jié)外科雜志(電子版);2010年04期

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本文編號(hào)：1931710