摘要
背景:高龄患者多伴有重要器官的功能减退和合并症,关注围手术期治疗是膝关节表面置换成功的关键。目的:70岁以上患者膝关节表面置换围手术期的常见并发症特点分析。设计、时间及地点:回顾性分析,2002-01/12赣南医学院第一附属医院和北京大学人民医院病例资料。对象:行膝关节表面置换109例168膝,男29例,女80例;单膝置换50例,年龄70～85岁,平均(74.2±15.1)岁;双膝置换59例,年龄70～85岁,平均(73.4±13.2)岁。92例(84.4%)体形肥胖,88例合并内科疾病。方法:手术由同一组人员完成。全部病例髌骨置换,使用假体均为Scorpio后稳定型膝关节假体。采用膝前正中切口和内侧髌旁入路,术中切除前后交叉韧带,清理后关节囊骨赘生物及游离体。假体安装完成后测试髌股关节轨迹,直至达到指压试验要求。假体均采用抗生素真空搅拌骨水泥固定,屈曲位缝合切口。主要观察指标:①置换后早期并发症。②膝关节功能评定。结果:①置换过程中及置换后24h以内发生高血压8例,低血压7例,心律失常6例,在相关科室治疗下,均安全度过围手术期。肺栓塞1例,伤口深部感染1例,肺部感染3例,泌尿系感染5例,速避宁导致的血小板急速下降并发症1例,一过性认知精神障碍1例,术后膝关节脱位1例。②HSS膝关节评分由置换前的26.1分提高到出院时的82.0分,功能评分由置换前的32.1分提高到出院时的89.1分。③经过平均12.4个月的随访,失访18例,回访率83.5%。回访的91例置换后膝关节疼痛消失或减轻、无假体松动和继发感染者,HSS膝关节评分由出院时82.0分增高至85.4分,功能评分由出院时的89.1分增高至92.3分。结论:熟练操作技巧,积极治疗合并症可有效预防置换后围手术期感染、脱位等并发症发生。
BACKGROUND： Critical organ hypofunction and complications are common in elderly patients, so perioperative treatment becomes important for the success of total knee replacement （TKR）.
OBJECTIVE： To explore clinical perioperative complications of TKR in the patients over 70 years old.
DESIGN, TIME AND SETTING： Retrospective analysis of case data was performed at First Hospital of Gannan Medical University and People＇s Hospital of Peking University from January to December 2002.
PARTICIPANTS： 109 patients （168 knees）, including 29 males and 80 females, underwent TKR. Of them, 50 underwent single knee surgery, aged （74.2± 15.1） years （range 70-85 years）, and 59 underwent bilateral knee surgery, aged （73.4± 13.2） years （range 70-85 years）. In addition, 92 cases （84.4%） were obesity, and 88 were complicated by internal diseases.
METHODS： The surgery was performed by the same operator. All patients underwent patellar replacement with Scorpio posterior stable knee prosthesis. Knee anterior median incision and medial patellar approach was applied, and anterior and posterior cruciate ligaments were excised during the surgery, osteophyma and corpus liberum of posterior articular capsule were cleared. Patellofemoral joint track was tested until meeting the requirements. The prosthesis was fixed using antibiotics mixed with bone cement, and the incision was sutured at flexed position. MAIN OUTCOME MEASURES： Early complications following replacement; knee joint and functional evaluation.
RESULTS： During surgery and 24 hours after replacement, 8 cases developed hypertension, 7 cases hypotension, and 6 cases arrhythmia. All patients safely passed the perioperative period under treatment of related departments. One case developed pulmonary embolism, 1 case deep infection, 3 cases pulmonary infection, 5 cases urinary system infection, 1 case rapid reduction of platelet caused by Subining, 1 case cognitive disturbance, and 1 case dislocation of knee joint （Charcot arthritis）. According to standards of HSS, the knee joint scores were significantly improved from 26.1 prior to replacement to 82.0 at discharge, and function scores were significantly improved from 32.1 prior to replacement to 89.1 at discharge. During 12.4-month follow-up （range 3-22 months）, 18 cases lost the follow up; the retention rate was 83.5%. Of 91 retention patients, knee pain disappeared or relieved, restored self-care ability, and no prosthesis loosening or infection was found. At the final follow up, the HSS knee joint scores were significantly improved from 82.0 at discharge to 85.4, and function scores were improved from 89.1 at discharge to 92.3 at discharge.
CONCLUSION： Skilled operative technique and positive treatment of complication can effectively prevent perioperative infection, dislocation and other complications following total knee replacement.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第30期5997-6000,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
