【摘要】 目的探讨晚期膝关节病患者应用行初次人工膝关节置换其术后并发症发生情况。方法回顾性分析中山大学附属第一医院关节外科2010年1月1日至2013年12月31日期间住院行初次人工全膝关节表面置换术(TKA)治疗的386例(422膝)晚期膝关节病患者,纳入标准包括:在中山大学附属第一医院诊断为"膝关节骨关节炎"、"类风湿性关节炎"、"膝关节色素绒毛结节滑膜炎""创伤性膝关节炎",行初次全膝关节表面置换术,为期至少4年的随访时间。排除标准包括:使用限制型、铰链式假体;伴有精神、心理疾病史;由于文化、语言、认知等原因不能配合。采用配对t检验统计手术前后膝关节活动度(ROM)。结果截至末次随访时,共有288例(317膝)获得随访,随访率为75.1%,随访时间平均(5.4±1.3)年。术后并发症:2例小腿肌间静脉血栓,2例肺部感染,1例膝关节结周围软组织感染,1例假体周围感染,1例右足干性坏疽,1例金属过敏性皮炎,5例伤口延迟愈合,3例僵直膝(ROM<50°),2例外伤后股骨假体周围髁上骨折,1例腓总神经一过性麻痹。患者术前膝关节ROM平均(94±23)°,与末次随访时(104±11)°比较差异有统计学意义(t=2.90,P<0.05)。结论 TKA是治疗终末期膝关节病的有效方法,可以明显缓解疼痛,改善功能,纠正关节畸形,做好围手术期处理并发症发生率较低,但要做好对应并发症的及时处理,因此加强患者TKA术后定期随诊具有重要意义。更多还原

【Abstract】 Objective To retrospectively analyze the mid-term clinical results and the complications after total knee arthroplasty( TKA),in order to summarize the possible ways to improve the outcome of TKA. Methods Between January,2010 and December,2013,386 patients( 422 knees) with advanced knee diseases who underwent TKAs at the Department of Joint Surgery,the First Affiliated Hospital of Sun Yatsen University were included. Selection criteria included the patients with "knee osteoarthritis", "rheumatoid arthritis", "traumatic knee arthritis", "knee pigmented villonodular synovitis",initial total knee arthroplasty,at least four years of follow-up time. Exclusion criteria included the use of restricted hinge prosthesis,parients accompanied by psychiatric disorders,patients who can not cooperate due to culture,language,cognitive reasons. The paired t test was used to measure the knee movement( ROM) before and after TKA. Results A total of 288 patients( 317 knees) were followed up with a follow-up rate of 75. 1%. The mean follow-up time was( 5. 4 ± 1. 3) years. Postoperative complications: two cases of calf muscle vein thrombosis; two cases of pulmonary infection; one case of soft tissue infection around knee joint; one case of knee joint prosthesis infection; one case of dry gangrene at right foot; one case of metal allergic dermatitis; five cases of delayed wound healing; three cases of stiff knee( ROM < 50 °); two cases of femoral shaft fractures above the prosthesis; one case of transient common peroneal nerve paralysis. The average ROM of knee improved from preoperative( 94 ± 23) ° to( 104 ± 11) ° at the last follow-up,which showed significant difference( t = 2. 90,P < 0. 05). Conclusion TKA is an effective method for the treatment of end-stage knee joint disease; meticulous peri-operative managements can reduce complications after TKA,and regularly following up is necessary for patients underwent TKA.更多还原