CAJ | 학술논문

目的探讨全膝关节置换术(TKA)后膝关节疼痛的原因和临床处理方法.方法 2004年1月至2009年6月,收治TKA术后疼痛患者41例,其中男性9例9膝,女性32例35膝;年龄51～84岁,平均63.5岁.关节外疼痛6例中1例为1型复杂区域疼痛综合征(CRPS-1)行保守治疗,其余5例手术治疗.关节内疼痛35例中关节失稳4例、髌骨低位1例、假体悬挂致周围软组织磨损2例、胭肌腱撞击1例采用保守治疗,其余27例手术治疗.定期随访并记录膝关节美国膝关节学会评分(KSS评分)、疼痛视觉模拟评分(VAS评分).结果 41例均获随访,随访时间1～6年.关节外疼痛手术5例,末次随访VAS评分、KSS临床和功能评分分别为2.5±0.2、92.8±2.6和89.0±3.4,膝关节疼痛缓解,功能改善.1例CRPS-1保守治疗,效果尚可.关节内疼痛感染组12例中截肢1例、抗生素骨水泥隔体植入3例、二期翻修8例,随访感染均治愈,术后VAS、KSS临床和功能评分分别为3.8±0.2、88.3±4.6和85.0±4.6,和术前相比差异有统计学意义(P＜0.05).非感染组保守治疗8例,末次随访VAS、KSS临床和功能评分4.5±0.4、85.4±4.2和84.2±2.3;手术治疗15例,末次随访VAS、KSS临床和功能评分3.4±0.1、86.6±5.4和87.1±2.4,与术前相比差异有统计学意义(P＜0.05).结论 TKA术后疼痛需要对手术和患者情况进行系统评估以明确其原因,确诊后制定合理治疗方案一般可获得满意效果,确诊之前严禁手术干预.
목적 탐토전슬관절치환술(TKA)후슬관절동통적원인화림상처리방법.방법 2004년1월지2009년6월,수치TKA술후동통환자41례,기중남성9례9슬,녀성32례35슬;년령51～84세,평균63.5세.관절외동통6례중1례위1형복잡구역동통종합정(CRPS-1)행보수치료,기여5례수술치료.관절내동통35례중관절실은4례、빈골저위1례、가체현괘치주위연조직마손2례、연기건당격1례채용보수치료,기여27례수술치료.정기수방병기록슬관절미국슬관절학회평분(KSS평분)、동통시각모의평분(VAS평분).결과 41례균획수방,수방시간1～6년.관절외동통수술5례,말차수방VAS평분、KSS림상화공능평분분별위2.5±0.2、92.8±2.6화89.0±3.4,슬관절동통완해,공능개선.1례CRPS-1보수치료,효과상가.관절내동통감염조12례중절지1례、항생소골수니격체식입3례、이기번수8례,수방감염균치유,술후VAS、KSS림상화공능평분분별위3.8±0.2、88.3±4.6화85.0±4.6,화술전상비차이유통계학의의(P＜0.05).비감염조보수치료8례,말차수방VAS、KSS림상화공능평분4.5±0.4、85.4±4.2화84.2±2.3;수술치료15례,말차수방VAS、KSS림상화공능평분3.4±0.1、86.6±5.4화87.1±2.4,여술전상비차이유통계학의의(P＜0.05).결론 TKA술후동통수요대수술화환자정황진행계통평고이명학기원인,학진후제정합리치료방안일반가획득만의효과,학진지전엄금수술간예.
Objective To evaluate causes and clinical management of postoperative pain after total knee arthroplasty(TKA). Methods From January 2004 to June 2009, 41 patients(44 knees)with knee pain post TKA were treated. There were 9 male and 32 female patients aging from 51 to 84 years with a mean of 63.5 years. The diagnosis followed to Brown diagnostic system. One case of extraarticular pain was complex regional pain syndrome type 1(CRPS-1)and underwent conservative treatment, the remaining 5cases were treated by surgery. Three cases of joint instability, 1 case of patellar baja, 2 cases of soft tissue impingement caused by overhang of the prosthesis, 1 case of popliteal tendon impact underwent conservative treatment, the other 27 cases underwent surgical intervention. The patients were followed up and the Knee Society Score(KSS)knee score, pain visual analog scale(VAS)score were recorded. Results Forty-one cases were followed up for 1 to 6 years. At the last time of follow-up, the 5 cases received surgical treatment to extra-articular pain showed VAS score as 2. 5 ± 0. 2, KSS clinical and functional score as 92. 8 ± 2. 6 and 89.0 ± 3.4. There was significantly difference compared with preoperative(P ＜ 0. 05). One case of CRPS-1 performed conservative treatment, the therapy was effective. In the infected 12 cases of intra-articular pain, 1 case received amputation, 3 cases received antibiotic bone cement insert, 8 cases received two stage revision. All infections were cured, and VAS score was 3. 8 ± 0. 2, KSS clinical score was 88. 3 ± 4.6,function score was 85.0 ± 4. 6 postoperatively, with significantly difference compared with preoperative(P ＜0. 05). In the 8 cases received conservative treatment in non-infected group, at the last time of follow-up,VAS score was 4. 5 ± 0. 4, KSS clinical and functional score was 85.4 ± 4. 2 and 84. 2 ± 2. 3, with significantly difference compared with preoperative(P ＜ 0. 05). Fifteen cases underwent surgical treatment,at the last time of follow-up, VAS score was 3.4 ± 0. 1, KSS clinical and functional score was 86. 6 ± 5.4and 87. 1 ± 2. 4, with significantly difference compared with preoperative(P ＜ 0. 05). Conclusions Patients with knee pain post TKA need systematic assessment to identify the causes. Appropriate treatment due to the positive diagnosis generally lead to satisfactory results, surgical intervention with indefinite causes is strictly prohibited.