中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (48): 8958-8962.doi: 10.3969/j.issn.2095-4344.2012.48.006

• 人工假体 artificial prosthesis • 上一篇    下一篇

血友病性关节炎患者的全膝关节置换

侯 波1，王 毅2，沈宇辉2，冯建民2，刘志宏2，何 川2   

  1. 1上海市伤骨科研究所，上海市 200025
    2上海交通大学附属瑞金医院骨科，上海市 200025
  • 收稿日期:2012-02-09 修回日期:2012-05-13 出版日期:2012-11-25 发布日期:2013-03-14
  • 通讯作者: 王毅，博士，主任医师，上海交通大学附属瑞金医院骨科，上海市 200025
  • 作者简介:侯波★，男，1983年生，山西省临汾市襄汾县人，汉族，2012年上海市伤骨科研究所毕业，硕士，主要从事膝关节功能重建研究。 houbostrive@163.com

Total knee arthroplasty in patients with hemophilic arthritis

Hou Bo1, Wang Yi2, Shen Yu-hui2, Feng Jian-min2, Liu Zhi-hong2, He Chuan2   

  1. 1Shanghai Institute of Traumatology and Orthopedics, Shanghai 200025, China
    2Department of Orthopedics, Affiliated Ruijin Hospital of Shanghai Jiao Tong University, Shanghai 200025, China
  • Received:2012-02-09 Revised:2012-05-13 Online:2012-11-25 Published:2013-03-14
  • Contact: Wang Yi, Doctor, Chief physician, Department of Orthopedics, Affiliated Ruijin Hospital of Shanghai Jiao Tong University, Shanghai 200025, China
  • About author:Hou Bo★, Master, Shanghai Institute of Traumatology and Orthopedics, Shanghai 200025, China houbostrive@163.com

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797

被引次数

8

摘要：

背景：血友病性膝关节炎患者行全膝关节置换的疗效与凝血因子替代治疗方案以及手术技术有直接关系。
目的：总结12例血友病性关节炎患者行全膝关节置换的效果，对患者围手术期的全程凝血因子Ⅷ监测和替代治疗方案进行阐述。
方法：以瑞金医院凝血因子替代方案为标准，结合患者实际凝血因子水平，搭配有经验的医生，对12例(17膝)男性血友病关节炎患者实施全膝关节置换，采用Cleveland膝关节评分和膝关节协会评分(KSS评分)进行功能评估。
结果与结论：根据Cleveland膝关节评分，优8膝，一般3膝，差3膝，1例大腿截肢患者和2例关节融合患者不参与该评分。根据KSS评分，膝关节评分从置换前(23.6±9.0)分增加到末次随访时的(86.7±12.1)分，平均膝关节功能评分从置换前(25.2±28.4)分增加到末次随访时的(65.7±39.8)分。结果可见对于血友病膝关节病患者，围手术期应用合理的凝血因子替代方案，关节功能得到了良好的恢复，但是风险较大，需要谨慎进行。

关键词: 血友病, 关节成形术, 膝关节, 凝血因子, 全膝关节置换

Abstract:

BACKGROUND: The effect of total knee arthroplasty for the treatment of hemophilic arthritis is directly related to the coagulation factor replacement treatment programs and surgical techniques.
OBJECTIVE: To summarize the rehabilitation outcome of 12 hemophilic arthritis patients treated with total knee arthroplasty, and to describe the coagulation factor Ⅷ monitoring and alternative treatment program in perioperative period.
METHODS: Take the coagulation factor replacement therapy scheme by Ruijin Hospital as a standard, combining with the actual factor level and experienced surgeon, we operated total knee arthroplasty for the 12 male patients (17 knees) with hemophilic arthritis. Function was assessed using the Cleveland score and the Knee Society Rating Scale.
RESULTS AND CONCLUSION: Results were excellent in 8 knees, fair in 3 knees and poor in 3 knees according to the Cleveland score, 1 thigh amputees and 2 patients who suffered from joint fusion surgery were not involved in this score. According to KSS score, average knee score increased from (23.6±9.0) preoperatively to (86.7±12.1) postoperatively, average knee function score increased from (25.2±28.4) preoperatively to (65.7±39.8) postoperatively. For the patients with hemophilic arthritis, reasonable alternative treatment program can promote the recovery of joint function, but it has bigger risk, so caution is necessary.

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