高屈曲假体加延长杆在晚期类风湿关节炎伴重度膝外翻畸形和严重骨质疏松患者中的临床疗效研究

发布时间：2018-10-07 18:46

【摘要】：目的探讨晚期类风湿关节炎(RA)伴重度膝外翻畸形和严重骨质疏松患者膝关节置换术假体选择及临床效果。方法选取2008—2014年兰州军区总医院全军骨科中心关节外科采用髌旁内侧入路、常规截骨加单纯外侧软组织松解方法治疗晚期RA伴重度膝外翻畸形和严重骨质疏松患者27例(32膝)。18例(20膝)采用不保留后十字韧带型后稳定型常规假体:Nex Gen HF-Flex常规膝(后稳定型组),9例(12膝)采用Nex Gen HF-Flex常规膝+延长杆(后稳定型+延长杆组)。采用术前及末次随访时膝关节屈曲挛缩、关节活动度、股胫角等评价手术效果。结果手术时间60~120 min,平均75 min。随访时间2.0~7.5年,平均4.9年。后稳定型组和后稳定型+延长杆组末次随访时膝关节屈曲挛缩较术前减少、关节活动度较术前提高(P0.05)。术前及末次随访时,后稳定型组与后稳定型+延长杆组膝关节屈曲挛缩、关节活动度比较,差异均无统计学意义(P0.05)。所有患者外翻畸形得到纠正,后稳定型组和后稳定型+延长杆组末次随访时股胫角较术前减小(P0.05)。术前及末次随访时,后稳定型组与后稳定型+延长杆组股胫角比较,差异均无统计学意义(P0.05)。术后3例(3膝)有膝关节外侧不稳症状,给予膝关节支具保护;2例(3膝)术后1个月出现下肢静脉血栓,给予放置下腔静脉滤网;1例(1膝)术后发生腓总神经麻痹。其余患者随访期间未发生假体感染、假体周围骨折、异位骨化、假体松动及外翻等术后并发症。结论对晚期RA伴重度膝外翻畸形和严重骨质疏松患者在假体选择方面,后稳定型假体与后稳定型假体+延长杆在纠正外翻屈曲畸形、关节活动度和股胫角疗效等方面,未见差异,所有患者近期疗效满意,但对于此类患者而言,后稳定型假体+延长杆组稳定性较好,受RA病程进展影响较低。
[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.
【作者单位】：兰州军区总医院全军骨科中心关节外科;第四军医大学西京医院老年病科;宁夏医科大学研究生院;
【基金】：国家自然科学基金资助项目(81371983) 甘肃省自然科学基金资助项目(1606RJZA208) 甘肃省科技支撑计划资助项目(S04671) 甘肃省青年科技基金资助项目(1606RJYA300)
【分类号】：R580;R687.4

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