CAJ | 학술논문

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.
목적 총결인공전슬관절번수술중기수방결과,연구불동번수책략대초차인공전슬관절치환술후감염치료적영향.방법 회고성분석1989년4월지2010년10월우북경대학인민의원관절병진료연구중심행인공전슬관절번수술적북경지구45례(47슬)환자자료.기중남성6례,녀성39례;행인공전슬관절번수술시년령31 ～77세,평균(62±11)세.환자행슬관절공능평고、종합상태평고、정신심리평고급영상학평고.완성미국슬관절학회평분(KSS)림상급공능평분、생활질량평개량표(SF-36)평분、서안대략화맥극마사특대학골관절염(WOMAC)평분、만의도급동통시각모의량표(VAS)평분.장환자안조인공전슬관절번수술괄응증시부위감염분위감염조(33례,34슬)화비감염조(12례,12슬).채용t검험진행조간、조내분석.결과 수방시간위1년2개월지17년,평균수방8년3개월.환자말차수방시KSS림상급공능평분[(66.9±28.0)화(44.4±37.6)분]교술전[(25.4±24.2)화(10.0±24.8)분]유명현제고(t=7.043화3.797,균P=0.001).감염조환자술전KSS림상급공능평분、사회공능현저저우비감염조(t=2.225、3.520화2.885,P=0.035、0.002화0.007).감염조행이기인공전슬관절번수술적환자술후KSS공능평분、사회공능、구체건강총평、WOMAC공능평분、WOMAC총평분여행일기인공전슬관절번수술적환자비교,차이유통계학의의(t =2.160～3.268,P=0.004～0.042).환자가체1、2、6、17년생존솔분별위83.6％、78.7％、62.1％、44.5％.결론 인공전슬관절번수술가개선인공전슬관절치환술실패후적동통급슬관절활동곤난,야가부분개선환자공능,제고생활질량.무감염환자수술효과우우유감염환자.유감염환자이기번수효과우우일기번수.일기여이기번수균위인공전슬관절치환술후감염적유효해결방안.
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'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 & 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.