摘要
目的探讨全膝关节置换术配合渐进式功能锻炼治疗重度膝骨关节炎合并帕金森病患者的疗效,并作对比分析。方法回顾性分析2015年6月至2016年12月收治的28例重度膝骨关节炎(knees osteoarthritis,KOA)合并帕金森(parkinson disease,PD)患者,均给予全膝关节置换术(total knee arthroplasty,TKA)配合渐进式康复运动锻炼,采用美国特种外科医院膝关节评分表(hospital for special surgery,HSS)、Berg平衡量表(the Berg balancescale,BBS)、Fugl-Meyer平衡功能量表(the Fugl-Meyer balance scale,FM-B)观察术前、术后6个月、术后1年评分,进行临床疗效对比,并观察术后1年并发症情况。结果 28例患者均获得随访,术后1年,1例患者因不慎摔跤,再次损伤膝关节;2例患者因PD病情加重,需手扶拐杖下行走;术后HSS评分总分由术前(23.56±3.64)分提升至术后6个月(78.49±12.65)分、术后1年随访时(87.421±15.34)分,与术前比较差异均有统计学意义(P<0.05);术后BBS评分总分由术前(32.58±6.77)分提升至术后6个月(47.72±8.24)分、术后1年随访时(50.13±9.17)分;术后FM-B评分总分由术前(36.57±5.17)分提升至术后6个月(43.58±7.19)分、术后1年随访时(50.13±9.17)分,与术前比较差异有统计学意义(P<0.05);术后6个月、术后1年有效率分别为86.71%、96.4%,两组有效率经秩和检验Z=-1.975,P=0.048。结论全膝关节置换术配合渐进式功能锻炼在重度KOA合并PD患者中的应用是一种有效安全的治疗方案,具有并发症少、膝关节功能恢复快、依存性高等优势,为临床研究提供可靠的理论和循证医学依据。
Objective To discuss the clinical effect of total knee arthroplasty combined with progressive functional exercise to treat severe knee osteoarthritis（KOA）with Parkinson＇s disease（PD）. Methods A retrospective analysis was performed on 28 patients with severe KOA and PD patients admitted to the hospital from June 2015 to December2016.The patients underwent total knee arthroplasty（TKA）combined with progressive functional exercise.Hospital for Special Surgery（HSS）score,Berg balance scale（BBS）and Fugl-Meyer balance function scale of before surgery,6 months and 1 year after the surgery were recorded.The result was compared.We also observed the complications 1 year after the surgery. Results All 28 patients were followed up.1 patient suffered a knee joint injury due to an accidental fall of 1 year after the operation.2 patients＇ PD got worse and had to walk under crutches.The total score of HSS score was（23.56±3.64）before surgery,and raised to（78.49±12.65）6 months after the surgery and（87.421±15.34）1 year after the operation.The differences were statistically significant compared with before surgery（P〈0.05）.The total score of BBS was（32.58±6.77）before surgery and（47.72±8.24）6 months after the surgery and（50.13±9.17）1 year after the operation.The total score of FM-B score was（36.57±5.17）before surgery and（43.58±7.19）6 months after the surgery and（50.13±9.17）score 1 year after the operation.The differences were statistically significant compared with before surgery（P〈0.05）.The effective rate of 6 months after surgery and 1 year after surgery were 86.71% and96.4% respectively,and the efficiency of the two groups was measured by rank and test Z=-1.975,P=0.048.Conclusion Total knee arthroplasty combined with progressive functional exercise is an effective and safe treatment in severe KOA with PD patients.It has the advantages of less complication,quick recovery of knee joint function and higher dependence,and provides reliable theoretical and evidence-based medical basis for clinical research.
作者
史永涛
白东昱
曹博
Shi Yongtao;Bai Dongyu;Cao Bo(Department of Joint Surgery,Affiliated Hospital of Yan＇an University,Yan＇an 716000,China)
出处
《实用骨科杂志》
2018年第9期778-781,805,共5页
Journal of Practical Orthopaedics
关键词
全膝关节置换术
膝骨关节炎
帕金森病
渐进式功能锻炼
total knee arthroplasty
knee osteoarthritis
Parkinsot＇s disease
progressive functional exercise
