全膝置换术治疗类风湿与退变性膝关节炎的比较研究

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Abstract Objective To compare the efficacy of total knee arthroplasty (TKA) for the treatment of rheumatoid arthritis and degenerative arthritis of the knee.Methods Clinical data of 68 cases (68 knees)with rheumatoid arthritis and degenerative arthritis of the knee who had undergone primary TKA procedure from December 2006 to December 2013 were retrospectively analyzed.There were 12 males and 56 females，aged from 40 to 84 years，with an average age of (61.6±9.7) years.They were divided into RA group and OA group by the different primary diseases.peroperative bleeding，operation time ，postoperative drainage volume，intraoperative and postoperative blood transfusion，recover time of muscle strength of four head of femur after operation，walking without stick time，postoperative aid use time，leaving a sickbed time，hospitalization time，claudication disappear time，postoperative limb swelling disappeared time，postoperative complication were recorded.Clinical evaluation of Arthroplasty has been made by referring to the Hospital for special surgery system、the Range of motion、the VAS pain scoring，the subjective satisfaction.According to the imaging observation of periprosthetic radiolucency component loosening as a judgment basis.Results All patients were followed up for 24 to 96 months (average 40.6 months).There were statistically significant between two groups in age，course of disease，peroperative bleeding，operation time ，postoperative drainage volume，intraoperative and postoperative blood transfusion，recover time of muscle strength of four head of femur after operation，walking without stick time，postoperative aid use time，leaving a sickbed time，hospitalization time，claudication disappear time，postoperative limb swelling disappeared time (P＜0.05).Among them，In 6 months after the operation，two groups of patients with HSS score，ROM，VAS pain score difference were statistically significant (P＜0.05)，and there was no significant difference in subjective satisfaction.At the last follow-up，there were no significant difference in HSS score、VAS pain score and subjective satisfaction.NO patellar and prosthetic loosening or infection was observed according to X-ray.In RA group：one case appeared postoperative deep venous thrombosis symptoms，one case had joint stiffness early，two cases had superficial infection，one case had extensor weakness.In OA group：one case had joint stiffness early，no DVT，superficial infection of the skin，inability to extend the knee and other complications.Conclusion TKA treatment of RA in patients with peri operative efficacy and postoperative early curative effect is worse than OA，but eventually the two early midterm no difference can achieve satisfactory clinical efficacy.

Key words： knee arthroplasty rheumatoid arthritis of the knee osteoarthritis

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