全膝关节置换术治疗甲型血友病膝关节病变的疗效分析 |
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引用本文: | 冯宾,翁习生,林进,翟吉良,钱文伟,盛林,边焱焱. 全膝关节置换术治疗甲型血友病膝关节病变的疗效分析[J]. 中华骨科杂志, 2010, 30(4). DOI: 10.3760/cma.j.issn.0253-2352.2010.04.009 |
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作者姓名: | 冯宾 翁习生 林进 翟吉良 钱文伟 盛林 边焱焱 |
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作者单位: | 中国医学科学院北京协和医学院北京协和医院骨科,北京,100730 |
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摘 要: | 目的 评价全膝关节置换术治疗甲型血友病膝关节病变的疗效、手术特点、假体选择及凝血因子替代治疗的有效性和安全性.方法 2003年6月至2009年4月,采用全膝关节置换术治疗甲型血友病膝关节病变患者19例(25膝);年龄18~54岁,平均33.4岁.Ⅷ因子替代治疗方案为手术当天补充至100%,术后3 d内80%以上,术后3 d至一周60%以上.术后进行以持续被动活动器(CPM)为主的功能锻炼,锻炼时机为Ⅷ因子输注后6 h内.观察比较手术前后膝关节HSS评分、疼痛、活动度及并发症.结果 18例(24膝)患者得到随访,随访时间7~54月,平均31个月.术前患者HSS评分为平均(51±14)分(31~64),术后HSS评分为平均(86±9.5)分(62~110).关节活动度由术前平均55°±26.3°(10°~100°),改善为术后平均82°±18.6°(60°~100°).屈曲畸形由术前平均19°±13°(0°~45°),改善为术后平均2.7°±3.2°(0°~10°).所有患者术后1~5 d时间内检测的平均Ⅶ因子浓度为74.07%.术后1例发生关节出血,1例发生腓总神经麻痹,1例患者术后17个月因假体感染行翻修术.结论 在合理补充凝血因子条件下,全膝关节置换术是治疗血友病膝关节病变的有效方法,可明显改善膝关节症状和活动度.
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关 键 词: | 血友病A 膝关节 因子Ⅷ 关节成形术 置换,膝 |
Outcome of total knee arthroplasty for end-stage type A hemophilic arthropathy |
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Abstract: | Objective To evaluate the outcome of total knee arthroplasty (TKA) for end-stage hemophilic arthropathy, the effectiveness and safety of factor Ⅷ replacement treatment, and the selection of prothesis. Methods Nineteen patients (25 knees) with type A hemophilic arthropathy underwent TKA from June 2003 to April 2009. The average age at index operation was 33.4 years old (range, 18-54 years). The level of coagulation factor for replacement treatment was 100% on operation day, >80% within 3 days after operation, >60% from the third day to the seventh day after operation. Clinical assessment included hospital for special surgery knee score(HSS), pain symptom, range of motion(ROM) and complication. Results Eigh-teen patients(24 knees) were followed-up, and the average duration was 31 months(range, 7-54 months). The average preperative HSS score was 51±14 (31-64), whereas the average postoperative HSS score was 86±9.5 (62-110). The average preoperative ROM was 55°±26.3°(60°-100°), whereas the average postoperative ROM was 82°±18.6°(10°-100°). Flexion contracture had improved from 19°±13°(0°-45°) preoperatively to 2.7°± 3.2°(0°-10°) postoperatively. The average serum factor Ⅷ level was 74.07% between the first day and the fifth day after operation. As for postoperative complication, one had a hemarthrosis and one had a paralysis of common peroneal nerve. One patient underwent revision surgery because of infection of femoral compo-nent 17 months later. Conclusion TKA is an effective treatment for end-stage bemophilic arthropathy of knee joint, it can provide good outcome and improve the quality of life. Reasonable factor Ⅷ replacement is the basis of successful treatment program. |
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Keywords: | Hemophilia A Knee joint Factor Ⅷ Arthroplasty,replacement,knee |
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