摘要
目的 总结人工全膝关节翻修术中期随访结果,研究不同翻修策略对初次人工全膝关节置换术后感染治疗的影响.方法 回顾性分析1989年4月至2010年10月于北京大学人民医院关节病诊疗研究中心行人工全膝关节翻修术的北京地区45例（47膝）患者资料.其中男性6例,女性39例;行人工全膝关节翻修术时年龄31 ～77岁,平均（62±11）岁.患者行膝关节功能评估、综合状态评估、精神心理评估及影像学评估.完成美国膝关节学会评分（KSS）临床及功能评分、生活质量评价量表（SF-36）评分、西安大略和麦克马斯特大学骨关节炎（WOMAC）评分、满意度及疼痛视觉模拟量表（VAS）评分.将患者按照人工全膝关节翻修术适应证是否为感染分为感染组（33例,34膝）和非感染组（12例,12膝）.采用t检验进行组间、组内分析.结果 随访时间为1年2个月至17年,平均随访8年3个月.患者末次随访时KSS临床及功能评分[（66.9±28.0）和（44.4±37.6）分]较术前[（25.4±24.2）和（10.0±24.8）分]有明显提高（t=7.043和3.797,均P=0.001）.感染组患者术前KSS临床及功能评分、社会功能显著低于非感染组（t=2.225、3.520和2.885,P=0.035、0.002和0.007）.感染组行二期人工全膝关节翻修术的患者术后KSS功能评分、社会功能、躯体健康总评、WOMAC功能评分、WOMAC总评分与行一期人工全膝关节翻修术的患者比较,差异有统计学意义（t =2.160～3.268,P=0.004～0.042）.患者假体1、2、6、17年生存率分别为83.6％、78.7％、62.1％、44.5％.结论 人工全膝关节翻修术可改善人工全膝关节置换术失败后的疼痛及膝关节活动困难,也可部分改善患者功能,提高生活质量.无感染患者手术效果优于有感染患者.有感染患者二期翻修效果优于一期翻修.一期与二期翻修均为人工全膝关节置换术后感染的有效解决方案.
Objective To summarize the mid-term follow-up results of revision of total knee arthroplasty and compare the different strategies for infective revisions.Methods All of 45 patients （47 operated knees） lived in Beijing were treated from April 1989 to October 2010 in Arthritis Clinic and Research Center,Peking University People＆#39;s Hospital.There were 6 male and 39 female patients,who aged from 31 to 77 years （mean （62 ± 11） years）.The function of knee,satisfaction and imaging then were compared retrospectively.American Knee Society Scores （KSS）,Westem Ontario ＆amp; McMaster University Osteoarthritis Index（WOMAC）,the medical outcomes study item short form health survey （SF-36） scales and satisfaction/pain visual analogue scales（VAS） of patients were evaluated.The patients were divided into infection group （33 patients,34 knees） and non-infection group （12 patients,12 knees） according to the indication of revision of total knee arthroplasty and compared by t-tests.Results The time from operation to follow-up was 1 year and 2 months to 17 years.The mid-term follow-up time was 8 years 3 months.There were significant improvements of KSS clinical and function scores （from 66.9 ± 28.0 and 44.4 ± 37.6 to 25.4 ±24.2 and 10.0 ±24.8,t =7.043 and 3.797,both P =0.001）.Patients of infection group had lower KSS clinical and function scores than non-infection group before operation,and lower Society Function （t =2.225,3.520 and 2.885,P =0.035,0.002 and 0.007）.About the septic group,the Ⅱ-stage group had significant better post-operation KSS function scores,Society Function,physical component summary,WOMAC functional score and WOMAC score than Ⅰ-stage group（t =2.160-3.268,P =0.004-0.042）.The 1-year,2-year,6-year,17-year survival rate were 83.6%,78.7%,62.1%,44.5%.Conclusions Revision total knee arthroplasty is an effective method for solving the failure of primary total knee arthroplasty.It can improve the pain and activity difficulty following the failure of primary total knee arthroplasty,and partially improve function along with quality of life.The results of non-infection group are better than infection group.There may be better results for Ⅱ-stage revision total knee arthroplasty than Ⅰ-stage revision.Both Ⅰ-stage and Ⅱ-stage revision total knee arthroplasty are effective.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2015年第10期757-762,共6页
Chinese Journal of Surgery
关键词
关节成形术
置换
膝
假体失效
随访研究
感染
Arthroplasty,replacement,knee
Prosthesis
Follow-up studies
Infection
