摘要目的 探讨膝关节置换术治疗晚期血友病性膝关节炎的临床疗效、手术特点及围手术期凝血因子替代治疗方法。方法 自2010年9月至2014年3月我科共对6例A型血友病性晚期膝关节炎患者行单侧全膝关节置换术，Amold分期Ⅳ期5例，Ⅴ期1例。观察围手术期凝血因子Ⅷ替代治疗过程、效果及膝关节置换术特点，对手术前及术后2年时患膝美国膝关节协会评分(the American knee society score，AKS)系统中的膝评分及功能评分进行比较。结果 随访时间2～5年，平均3.6年。全膝关节置换术后早期无关节内出血、皮肤裂开，晚期无关节出血、假体松动、下沉，AKS膝评分从术前(57.7±5.6)分上升至术后2年时(97.0±1.4)分，功能评分从(65.0±6.3)分升至(92.5±4.2)分。结论 全膝关节置换术治疗晚期血友病性膝关节炎需在确保凝血因子理想活性的前提下进行，手术难度较大，但效果满意，是治疗晚期血友病性膝关节炎安全、理想的措施。
Abstract：Objective To explore the effect of total knee replacement for the treatment of anaphase hemophilic knee arthropathy，and to study the operative characteristics and the coagulation factor replacement therapy perioperatively.Methods 6 patients with anaphase hemophilic knee arthropathy underwent unilateral total knee replacement were followed from September 2010 to March 2014.All cases were type A hemophilia with grade Ⅳ 5 and grade Ⅴ 1 according to Amold staging.Those were observed including the process and effect of human coagulation factorⅧ replacement therapy in perioperative，the characteristics of total knee replacement for anaphase hemophilic knee arthropathy and the complications.According to AKS(the American knee society score)the knee score and the function score were compared before operation and after 2 years.Results 6 cases were followed up from 2to 5 years with the average of 3.6.There weren’t any articular hemorrhage and incision dehiscence after early，prosthesis loosening later.The knee score rose from (57.7±5.6) before to (97.0±1.4) 2 years after operation.The function score rose from (65.0±6.3) to (92.5±4.2).Conclusion Total knee replacement is a safe and idea terminal therapy for anaphase hemophilic knee arthropathy under ensuring the activity of coagulation factors although the operation is difficult.
余新平，刘康，梁建基，何智勇，王金军. 膝关节置换术治疗晚期血友病性膝关节炎[J]. 实用骨科杂志, 2017, 23(1): 17-20.
Yu Xinping，Liu Kang，Liang Jianji，et al. The Clinical Study of Total Knee Replacement for the Treatment of Anaphase Hemophilic Knee Arthropathy. sygkzz, 2017, 23(1): 17-20.
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