类风湿性关节炎关节置换：围置换期的主要风险管理

doi:10.3969/j.issn.2095-4344.2015.53.019

摘要/Abstract

摘要：

背景：类风湿性关节炎患者行关节置换过程中出现心血管疾病的风险及置换后出现感染、伤口愈合问题等并发症的概率较大。
目的：回顾总结类风湿性关节炎患者在关节置换围置换期易出现的各种风险，并对这些风险进行评估、提出解决方案以指导临床进行更好的围置换期管理。
方法：由第一作者应用计算机检索2000 至2015 年PubMed 数据库、GOOGLE 学术数据库、CNKI 数据库、万方数据库、维普数据库，纳入有关类风湿性关节炎关节置换围手术期心血管风险、感染风险的研究，中文检索词为“类风湿性关节炎，关节置换术，围手术期管理，感染，术后并发症，激素，改变病情抗风湿药，生物抑制剂”，英文检索词为“Rheumatoid arthritis，Total joint arthroplasty，Perioperative management, Infection，Postsurgical complications, Corticosteroid，Disease modifying antirheumatic drugs，Biologics”。排除陈旧性及重复性研究。
结果与结论：共检索到97篇文献，纳入44 篇，排除53篇内容与研究主题不符的文献。关节置换前应对类风湿性关节炎患者进行全面心血管检查，如伴有不稳定性心血管疾病应先对这些疾病治疗，否则需对患者进行心功能检查，并对此进行评估，预测手术风险；围置换期应合理安排抗风湿药物及激素，达到降低置换后感染和防止病情复发的平衡；类风湿性关节炎常易侵蚀颈椎，关节置换前应常规行影像学检查，如需要全麻时动作应轻柔。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨科植入物, 人工假体, 类风湿性关节炎, 关节置换, 围手术期管理, 手术后并发症, 抗风湿药

Abstract:

BACKGROUND: Patients with rheumatoid arthritis have high cardiovascular disease risks and postsurgical complications such as postoperative infection and wound healing problems in the process of total joint arthroplasty.
OBJECTIVE: To retrospectively review the peri-operative risks when undergoing total joint replacement in patients with rheumatoid arthritis, and assess these risks, propose solutions to guide clinical practice for better peri-operative management.
METHODS: The studies related with perioperative cardiovascular risk, the risk of infection of total joint replacement were retrieved by the first author from PubMed database, GOOGLE academic database, CNKI database, Wanfang database, VIP database from 2000 to 2015 through computer. The key words in English and Chinese were respectively “Rheumatoid arthritis, Total joint arthroplast, Perioperative management, Infection, Postsurgical complications, Corticosteroid, Disease modifying antirheumatic drugs, Biologics”. Old and repetitive
studies were excluded.

RESULTS AND CONCLUSION: A total of 97 articles were retrieved. Totally 53 articles which content was inconsistent with the research themes were excluded, and 44 papers were included in the analysis. We should make a comprehensive cardiovascular examination for the patients with rheumatoid arthritis before operation. If the cardiovascular disease of the patient is unstable, this condition should be clarified and treated appropriately before surgery, otherwise, patients need to check heart function, and predict the operation risk; We should reasonably arrange the anti-rheumatism medicines and corticosteroid during perioperative, so as to make a balance between reducing postoperative infection and preventing the condition relapse; Because rheumatoid arthritis often easy to erode the cervical spine, we should conduct routine imaging examination for the patients before total joint replacement. Movement should be gentle when general anesthesia was needed.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

中图分类号:

R318

高展望，甄平. 类风湿性关节炎关节置换：围置换期的主要风险管理[J]. 中国组织工程研究, 2015, 19(53): 8664-8669.

Gao Zhan-wang, Zhen Ping. Management of perioperative main risks for total joint arthroplasty in patients with rheumatoid arthritis[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(53): 8664-8669.

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