Chen Fen-Yong, Yang Feng-E, Chen Qi
CHENDepartment of Orthopaedics, Union Hospital Affiliated to Fujian Medical University, Fuzhou 350000, Fujian, China.
Zhongguo Gu Shang. 2011 Dec;24(12):1001-4.
To study the efficacy of total knee anhmplasty (TKA) for the treatment of hemophilic knee arthropathy, and to explore the operative characteristics, the selection of prothesis, the effectiveness and safety of clotting factor replacement treatment.
From January 2008 to June 2010, 10 patients (12 knees)with hemophilic anhropathv underwent TKA. The average age was 33.6 years old (ranged, 17 to 49 years). There was 8 cases of type A hemophilia and 2 cases of type B hemophilia. According to Arnold and Hilgartner classification: 7 knees were IV degree and 5 knees were V degree. The level of VIII factor for replacement treatment was more than 80% on operation day, more than 60% within 3 days after operation, more than 40% from the third day to the second week after operation. Added prothrombin complex concentrate (PCC) to improve the level of IX factor, and the level of IX factor for replacement treatment was more than 40% on operation day, more than 30% within 3 days after operation, more than 20% from the third day to the second week after operation. Functional training was mainly based on continuous passive motion (CPM) device after surgery. Clinical assessment included hospital for special surgery knee score (HSS) and the individual scores (including pain, function, activity, muscle strength, flexion deformity and stability).
Ten patients (12 knees) were followed-up, and the average duration was 11 months (ranged, 6 to 24 months). The average preoperative HSS score was (44.9 +/- 12.5) (ranged, 29 to 62 scores), whereas the average postoperative HSS score was (84.4 +/- 10.2) (ranged 72 to 96 scores) (P < 0.01). The preoperative individual score including pain, function, activity, muscle strength flexion deformity and stability were significantly improved compared with pre-operation, the differences between them were statistically significant (P < 0.01 ). TKA had the distinct role in relieving pain from preoperative (8.5 +/- 4.1) to postoperative (24.5 +/- 4.4).
Under the strict perioperative coagulation factor replacement therapy, TKA is a safe and an effective treatment for hemophmc anhmpathy of knee joint, whicht can effectively relieve pain and improve joint function.
研究全膝关节置换术（TKA）治疗血友病性膝关节病的疗效，探讨手术特点、假体选择及凝血因子替代治疗的有效性和安全性。
2008年1月至2010年6月，10例（12膝）血友病性关节病患者接受TKA。平均年龄33.6岁（17～49岁）。甲型血友病8例，乙型血友病2例。根据Arnold和Hilgartner分类：IV度7膝，V度5膝。置换治疗时VIII因子水平手术日大于80%，术后3天内大于60%，术后第3天至第2周大于40%。加用凝血酶原复合物浓缩剂（PCC）提高IX因子水平，置换治疗时IX因子水平手术日大于40%，术后3天内大于30%，术后第3天至第2周大于20%。术后功能训练主要基于持续被动运动（CPM）装置。临床评估包括特种外科医院膝关节评分（HSS）及单项评分（包括疼痛、功能、活动、肌力、屈曲畸形和稳定性）。
10例（12膝）患者获随访，平均随访时间11个月（6～24个月）。术前HSS平均评分为（44.9±12.5）分（29～62分），术后HSS平均评分为（84.4±10.2）分（72～96分）（P<0.01）。术前包括疼痛、功能、活动、肌力、屈曲畸形和稳定性的单项评分与术前相比均显著改善，差异有统计学意义（P<0.01）。TKA在缓解疼痛方面作用显著，从术前的（8.5±4.1）分降至术后的（2.5±4.4）分。
在严格的围手术期凝血因子替代治疗下，TKA是治疗血友病性膝关节病安全有效的方法，能有效缓解疼痛，改善关节功能。
