老年膝关节退行性骨关节炎的手术时机选择和疗效

目的观察不同年龄阶段老年骨关节炎患者关节置换术后恢复情况,为临床骨关节病手术时机的选择和预后判断提供理论依据。方法本文为前瞻性对照研究,研究对象为老年晚期骨关节炎、内科治疗无效、疼痛明显、并进行膝关节置换术后的患者,对患者术前及术后6周、6个月、12个月分别进行功能和症状评价。结果 102名患者平均年龄为75岁,根据不同年龄阶段分为三组,A组：60-70岁51人,B组：70-75岁33人,C组：75-80岁18人。A组患者术前平均骨关节炎指数评分（Western Ontario and McMaster Universities Osteoarthritis Index,WOMAC）为96.2分,B组为96.7,C组为95.7。术后A组患者的WOMAC评分平均减少了24分,B组减少了37分,C组减少了13分,三组患者有明显差别。B患者改善程度最大,C组患者最差,在SF-12评分,ADL评分显示了同样的差别。结论对于老年骨关节病患者来说,尽管手术有一定风险,却能有良好的长期疗效,在膝关节功能恢复和提高的程度上,70-75岁之间进行人工全膝关节置换的患者膝关节功能的提高程度优于其他组患者,是最适合的手术时机。

The kneel Joint Replacement Surgery timing for patients with knee osteoarthritis in eld

Objective Osteoarthritis(OA) of the knee is a common cause of pain and disability in elderly patients.Joint replacement surgery can alleviate pain and restore function but is associated with risks and discomfort.So we investigate the clinical results and complications of total knee arthroplasty(TKA) performed for different ages.Methods We conducted a prospective cohort study to examine decision making and clinical outcomes for elder patients(age > 60 years) with severe OA of the knee with symptoms inadequately controlled with conservative treatments.Osteoarthritis symptoms and functional status were assessed at baseline and at 12 months.Postoperative symptoms and function were assessed 6 weeks,6 months,and 12 months after surgery.Results For the 102 patients studied(mean age,75 years,A group 60-70 years,51,B group 70-75 years,33,C group > 75 years,18) the mean Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) score was 96 on a 100-point scale in early stage,96.7 in B group and 95.7 in C group.At 12 months,WOMAC scores improved by 24 points in the A group patients,37 in the B group patients and 13 point in the C group patients(P <0.001).Conclusions Joint Replacement is good for patients between 70 to 75 years with osteoarthritis.