• 中國醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院 北京協(xié)和醫(yī)院骨科 （北京，100730）;

【摘 要】 目的  探討下肢多關(guān)節(jié)置換治療晚期關(guān)節(jié)疾患的有效性。 方法  回顧分析2000年1月－2007年12月行下肢3個(gè)或以上關(guān)節(jié)置換的5例患者臨床資料。男3例，女2例，年齡27～59歲，平均41.8歲。強(qiáng)直性脊柱炎2例，類風(fēng)濕性關(guān)節(jié)炎3例；均為下肢髖、膝關(guān)節(jié)受累。4例完全喪失行走功能，1例患者扶拐可自行活動(dòng)。髖關(guān)節(jié)功能根據(jù)Harris評(píng)分標(biāo)準(zhǔn)為（24 ± 24）分，膝關(guān)節(jié)功能根據(jù)美國特種外科醫(yī)院（HSS）評(píng)分標(biāo)準(zhǔn)為（28 ± 15）分。一期多關(guān)節(jié)置換2例，二期置換2例，三期置換1例。 結(jié)果  術(shù)后患者切口均Ⅰ期愈合。1例術(shù)后發(fā)生髖關(guān)節(jié)脫位，手法復(fù)位后給予下肢制動(dòng)皮牽引3周，無關(guān)節(jié)再脫位發(fā)生。2例術(shù)后2 d內(nèi)出現(xiàn)貧血，給予積極擴(kuò)容補(bǔ)充紅細(xì)胞后改善。5例患者均獲隨訪，隨訪時(shí)間46～140個(gè)月，平均75個(gè)月?；颊呋灸苷Ｐ凶呒吧?、下樓梯。髖、膝關(guān)節(jié)穩(wěn)定性好，無關(guān)節(jié)感染及松動(dòng)發(fā)生。末次隨訪時(shí)，髖關(guān)節(jié)功能根據(jù)Harris評(píng)分為（88 ± 6）分，與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義（t=8.16，P=0.00）；膝關(guān)節(jié)功能根據(jù)HSS評(píng)分為（86 ± 6）分，與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義（t=13.96，P=0.00）。 結(jié)論  下肢多關(guān)節(jié)置換是治療晚期關(guān)節(jié)疾患的有效方法，可顯著提高患者生活質(zhì)量。

引用本文： 邊焱焱,翁習(xí)生,林進(jìn),金今,錢文偉,翟吉良,趙麗娟. 多關(guān)節(jié)置換治療晚期下肢關(guān)節(jié)疾患. 中國修復(fù)重建外科雜志, 2012, 26(3): 296-299. doi: 復(fù)制

1. Lee JH, Jun JB, Jung S, et al. Higher prevalence of peripheral arthritis among ankylosing spondylitis patients. J Korean Med Sci, 2002, 17 (5): 669-673.
2. 楊玉輝, 張遠(yuǎn)鷹, 王金成, 等. 強(qiáng)直性脊柱炎雙側(cè)髖膝關(guān)節(jié)骨性強(qiáng)直的功能重建. 中國矯形外科雜志, 2008, 16(1): 23-26.
3. Yano K, Ikari K, Inoue E, et al. Effect of total knee arthroplasty on disease activity in patients with established rheumatoid arthritis: 3-year follow-up results of combined medical therapy and surgical intervention. Mod Rheumatol, 2010, 20(5): 452-457.
4. Oliveira CR. Ankylosing spondylitis and anesthesia. Rev Bras Anestesiol, 2007, 57(2): 214-222.
5. Oyama T, Oqoshi K, Kanai A, et al. Continuous intrathecal anesthesia for total hip arthroplasty in a patient with ankylosing spondylitis. Masui, 2010, 59(8): 1028-1031.
6. Hamano N, Murao K, Sakamoto S, et al. Anesthesia for a severe ankylosing spondylitis patient whose posture had been restricted to only sitting for over 20 years. Masui, 2002, 51(9): 1026-1028.
7. Scott RD. Total hip and knee arthroplasty in juvenile rheumatoid arthritis. Clin Orthop Relat Res, 1990, (259): 83-91.
8. Head WC, Paradies LH. Ipsilateral hip and knee replacements as a single surgical procedure. J Bone Joint Surg (Am), 1977, 59(3): 352-354.
9. Souter WA. Planning treatment of the rheumatoid hand. Hand, 1979, 11(1): 3-16.
10. 呂厚山, 陳曉欣. 類風(fēng)濕性關(guān)節(jié)炎下肢畸形手術(shù)順序選擇的初步經(jīng)驗(yàn). 中華骨科雜志, 1995, 15(8): 483-486.
11. 楊佩, 王春生, 王坤正, 等. 強(qiáng)直性脊柱炎股骨近段形態(tài)學(xué)改變對全髖關(guān)節(jié)置換術(shù)假體選擇的意義. 中國修復(fù)重建外科雜志, 2006, 20(4): 448-450.
12. LIAO Qiande, ZHONG Da, WANG Shijie, et al. Cementless total hip arthroplasty for ankylosing spondylitis in 27 cases. 中國組織工程研究與臨床康復(fù), 2008, 12(44): 8797-8800.
13. 喻忠, 王黎明, 宋華榮, 等. 嚴(yán)重髖關(guān)節(jié)屈曲強(qiáng)直畸形關(guān)節(jié)置換. 中國矯形外科雜志, 2006, 14(11): 817-820.
14. Ojima T, Yokogawa A, Yamakado K, et al. Bilateral total knee arthroplasty after spontaneous osseous ankylosis in rheumatoid arthritis. Mod Rheumatol, 2005, 15(2): 139-143.
15. Kelly MA, Clarke HD. Stiffness and ankylosis in primary total knee arthroplasty. Clin Orthop Relat Res, 2003, (416): 68-73.
16. 閆飛, 陳光興, 楊柳, 等. 微創(chuàng)人工關(guān)節(jié)置換治療髖關(guān)節(jié)強(qiáng)直. 第三軍醫(yī)大學(xué)學(xué)報(bào), 2011, 33(14): 1518-1521.
17. 陳成亮, 宋樹春, 鄒士平, 等. 同期髖膝多關(guān)節(jié)置換的臨床應(yīng)用. 醫(yī)藥論壇雜志, 2011, 32(1): 52-54.
  1. 1. Lee JH, Jun JB, Jung S, et al. Higher prevalence of peripheral arthritis among ankylosing spondylitis patients. J Korean Med Sci, 2002, 17 (5): 669-673.
  2. 2. 楊玉輝, 張遠(yuǎn)鷹, 王金成, 等. 強(qiáng)直性脊柱炎雙側(cè)髖膝關(guān)節(jié)骨性強(qiáng)直的功能重建. 中國矯形外科雜志, 2008, 16(1): 23-26.
  3. 3. Yano K, Ikari K, Inoue E, et al. Effect of total knee arthroplasty on disease activity in patients with established rheumatoid arthritis: 3-year follow-up results of combined medical therapy and surgical intervention. Mod Rheumatol, 2010, 20(5): 452-457.
  4. 4. Oliveira CR. Ankylosing spondylitis and anesthesia. Rev Bras Anestesiol, 2007, 57(2): 214-222.
  5. 5. Oyama T, Oqoshi K, Kanai A, et al. Continuous intrathecal anesthesia for total hip arthroplasty in a patient with ankylosing spondylitis. Masui, 2010, 59(8): 1028-1031.
  6. 6. Hamano N, Murao K, Sakamoto S, et al. Anesthesia for a severe ankylosing spondylitis patient whose posture had been restricted to only sitting for over 20 years. Masui, 2002, 51(9): 1026-1028.
  7. 7. Scott RD. Total hip and knee arthroplasty in juvenile rheumatoid arthritis. Clin Orthop Relat Res, 1990, (259): 83-91.
  8. 8. Head WC, Paradies LH. Ipsilateral hip and knee replacements as a single surgical procedure. J Bone Joint Surg (Am), 1977, 59(3): 352-354.
  9. 9. Souter WA. Planning treatment of the rheumatoid hand. Hand, 1979, 11(1): 3-16.
  10. 10. 呂厚山, 陳曉欣. 類風(fēng)濕性關(guān)節(jié)炎下肢畸形手術(shù)順序選擇的初步經(jīng)驗(yàn). 中華骨科雜志, 1995, 15(8): 483-486.
  11. 11. 楊佩, 王春生, 王坤正, 等. 強(qiáng)直性脊柱炎股骨近段形態(tài)學(xué)改變對全髖關(guān)節(jié)置換術(shù)假體選擇的意義. 中國修復(fù)重建外科雜志, 2006, 20(4): 448-450.
  12. 12. LIAO Qiande, ZHONG Da, WANG Shijie, et al. Cementless total hip arthroplasty for ankylosing spondylitis in 27 cases. 中國組織工程研究與臨床康復(fù), 2008, 12(44): 8797-8800.
  13. 13. 喻忠, 王黎明, 宋華榮, 等. 嚴(yán)重髖關(guān)節(jié)屈曲強(qiáng)直畸形關(guān)節(jié)置換. 中國矯形外科雜志, 2006, 14(11): 817-820.
  14. 14. Ojima T, Yokogawa A, Yamakado K, et al. Bilateral total knee arthroplasty after spontaneous osseous ankylosis in rheumatoid arthritis. Mod Rheumatol, 2005, 15(2): 139-143.
  15. 15. Kelly MA, Clarke HD. Stiffness and ankylosis in primary total knee arthroplasty. Clin Orthop Relat Res, 2003, (416): 68-73.
  16. 16. 閆飛, 陳光興, 楊柳, 等. 微創(chuàng)人工關(guān)節(jié)置換治療髖關(guān)節(jié)強(qiáng)直. 第三軍醫(yī)大學(xué)學(xué)報(bào), 2011, 33(14): 1518-1521.
  17. 17. 陳成亮, 宋樹春, 鄒士平, 等. 同期髖膝多關(guān)節(jié)置換的臨床應(yīng)用. 醫(yī)藥論壇雜志, 2011, 32(1): 52-54.