全膝关节置换术治疗甲型血友病膝关节病变的疗效分析

目的 评价全膝关节置换术治疗甲型血友病膝关节病变的疗效、手术特点、假体选择及凝血因子替代治疗的有效性和安全性.方法 2003年6月至2009年4月,采用全膝关节置换术治疗甲型血友病膝关节病变患者19例(25膝);年龄18～54岁,平均33.4岁.Ⅷ因子替代治疗方案为手术当天补充至100%,术后3 d内80%以上,术后3 d至一周60%以上.术后进行以持续被动活动器(CPM)为主的功能锻炼,锻炼时机为Ⅷ因子输注后6 h内.观察比较手术前后膝关节HSS评分、疼痛、活动度及并发症.结果 18例(24膝)患者得到随访,随访时间7～54月,平均31个月.术前患者HSS评分为平均(51±14)分(31～64),术后HSS评分为平均(86±9.5)分(62～110).关节活动度由术前平均55°±26.3°(10°～100°),改善为术后平均82°±18.6°(60°～100°).屈曲畸形由术前平均19°±13°(0°～45°),改善为术后平均2.7°±3.2°(0°～10°).所有患者术后1～5 d时间内检测的平均Ⅶ因子浓度为74.07%.术后1例发生关节出血,1例发生腓总神经麻痹,1例患者术后17个月因假体感染行翻修术.结论 在合理补充凝血因子条件下,全膝关节置换术是治疗血友病膝关节病变的有效方法,可明显改善膝关节症状和活动度.

Outcome of total knee arthroplasty for end-stage type A hemophilic arthropathy

Objective To evaluate the outcome of total knee arthroplasty (TKA) for end-stage hemophilic arthropathy, the effectiveness and safety of factor Ⅷ replacement treatment, and the selection of prothesis. Methods Nineteen patients (25 knees) with type A hemophilic arthropathy underwent TKA from June 2003 to April 2009. The average age at index operation was 33.4 years old (range, 18-54 years). The level of coagulation factor for replacement treatment was 100% on operation day, >80% within 3 days after operation, >60% from the third day to the seventh day after operation. Clinical assessment included hospital for special surgery knee score(HSS), pain symptom, range of motion(ROM) and complication. Results Eigh-teen patients(24 knees) were followed-up, and the average duration was 31 months(range, 7-54 months). The average preperative HSS score was 51±14 (31-64), whereas the average postoperative HSS score was 86±9.5 (62-110). The average preoperative ROM was 55°±26.3°(60°-100°), whereas the average postoperative ROM was 82°±18.6°(10°-100°). Flexion contracture had improved from 19°±13°(0°-45°) preoperatively to 2.7°± 3.2°(0°-10°) postoperatively. The average serum factor Ⅷ level was 74.07% between the first day and the fifth day after operation. As for postoperative complication, one had a hemarthrosis and one had a paralysis of common peroneal nerve. One patient underwent revision surgery because of infection of femoral compo-nent 17 months later. Conclusion TKA is an effective treatment for end-stage bemophilic arthropathy of knee joint, it can provide good outcome and improve the quality of life. Reasonable factor Ⅷ replacement is the basis of successful treatment program.