骨性关节炎和炎症性关节炎行全膝关节置换翻修术临床效果的比较及相关分析

目的对应用单一翻修假体系统行膝关节置换翻修术的骨性关节炎与炎症性关节炎的临床材料进行汇总分析、对比。方法1994至2000年间，共69例患者71膝在芬兰坦配雷大学医学院医院应用翻修假体TCⅢ行全膝关节置换翻修术。56膝为女性，16膝为男性，平均年龄69．1岁（36～85岁），平均随访时间为5.9年（3．0—10．2年）；16膝为炎症性关节炎，55膝为骨性关节炎，初次手术和翻修术的时间间隔平均为6．8年。临床评估参照KSS评分系统，再次翻修、截肢和死亡视为随访终止。结果所有患者术后1年和最终随访时的膝关节总评分、功能评分、活动范围、疼痛评分、行走评分及上楼评分等与术前相比差异有统计学意义（P〈0．001）。尽管23例假体周围有无症状性骨吸收线，但是关节均无明显结构上的松脱。并发症包括4例术后感染，1例髌骨疼痛综合症，1例髌腱断裂。以再次翻修作为终点，假体5年生存率为95％，8年生存率为94％。最终随访时，骨性关节炎患者的各项数据比炎症性关节炎患者稍好，但统计学分析结果示两组之间的差异无统计学意义。结论尽管炎症性关节炎会导致患者韧带松弛，容易感染，骨质破坏，一般情况较差，但是其行全膝关节置换翻修术的疗效与骨关节炎相接近。

Clinical effects of revision total knee arthroplasty:a comparative analysis between osteoarthritis and inflammatory arthritis

Objective To evaluate and compare the results of individual revision prosthesis systems performed in osteoarthritis and inflammatory arthritis. Methods From 1994 to 2000, 71 revision total knee arthroplasties had been performed in Tampere University Hospital on 69 patients （56 female, 16 male,2 bilateral） using the TC Ⅲ system . 16 knees were affected by inflammatory arthritis and 55 by osteoarthritis. The average interval between revision and the first arthroplasty were 6.8 years. Patients were followed-up for 5.9 （3. 0 - 10. 2） years, using KSS as the reference. Rerevision, amputation and death were as the endpoint. Results At 1 year after revision and at final follow-up, the total Knee Society knee score, function score and range of motion had improved （ P 〈 0. 001 ） with no differences between osteoarthritis and inflammatory arthritis. No knee had definite component loosening, although 23 knees had asymptomatie radiolucent lines. Complications comprised 4 infections, 1 patellar pain syndrome and 1 rupture of the patellar tendon. Using re-revision of the prosthesis as the endpoint, 5-year survival was 95% and 8-year survival was 94%. Datas in patients of osteoarthritis were better than inflammatory arthristis at the final follow-up, however , there were no statistical difference between these two groups. Conclusions Although inflammatory arthritis may cause ligamentous laxity, propensity to develop infections, bone destruction and poor general health, patients with inflammatory arthritis had results similar to those with osteoarthritis.