Li Xin, Li Heng, Ni Ming, Li Xiang, Song Xinggui, Kong Xiangpeng, Li Yucong, Chen Jiying
Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Nov 8;30(11):1358-1365. doi: 10.7507/1002-1892.20160278.
To evaluate the application and effectiveness of bilateral total hip arthroplasty and total knee arthroplasty in the treatment of severe inflammatory arthropathies.
Between September 2008 and September 2015, 31 patients with severe inflammatory arthropathies were treated with bilateral total hip arthroplasty and total knee arthroplasty. Of 31 cases, 22 were male and 9 were female with an average age of 30 years (range, 20 to 41 years); there were 15 cases of rheumatoid arthritis and 16 cases of ankylosing spondylitis with an average onset age of 14 years (range, 5-28 years); all 4 ankylosed joints were observed in 11 cases, 3 ankylosed joints in 2 cases, 2 ankylosed joints in 6 cases, 1 ankylosed joint in 1 case, and no ankylosed joint in 11 cases. Before operation, the hip range of motion (ROM) value was (17.82±28.18)°, and the knee ROM value score was (26.45±30.18)°; the hip Harris score was 29.64±11.58, and the hospital for special surgery (HSS) score was 27.07±11.04. The patients were grouped and compared in accordance with etiology and ankylosed joint.
One-stage arthroplasty was performed in 1 case, two-stage arthroplasty in 22 cases, three-stage arthroplasty in 7 cases, and four-stage arthroplasty in 1 case. The total operation time was 325-776 minutes; the total blood loss was 900-3 900 mL; the total transfusion volume was 2 220-8 070 mL; and the total hospitalization time was 21-65 days. The patients were followed up 12-94 months (mean, 51 months). The hip and knee ROM values, Harris score and HSS score at last follow-up were significantly improved when compared with preoperative ones (<0.05). The subjective satisfaction degree was good in 16 cases, moderate in 10 cases, and poor in 5 cases. Periprosthetic infection occurred in 2 cases (3 knees), joint stiffness in 3 cases (6 knees), joint instability in 1 case (1 knee), leg length discrepancy of >2 cm in 2 cases, and flexion deformity of 10° in 1 case (1 knee). The hip and knee ROM values, Harris score and HSS score showed no significant difference between patients with ankylosing spondylitis and patients rheumatoid arthritis at last follow-up (>0.05). The hip and knee ROM values of the patients with ankylosed joint were significantly lower than those of patients with no ankylosed joint (<0.05); the Harris score and HSS score of the patients with ankylosed joint were lower than those of patients with no ankylosed joint, but no significant difference was found (>0.05).
A combination of bilateral hip and knee arthroplasty is an efficient treatment for severe lower extremities deformity, arthralgia and poor quality of life caused by inflammatory arthropathies. However, the postoperative periprosthetic infection and stiffness of knee are important complications influencing the effectiveness of operation.
评估双侧全髋关节置换术和全膝关节置换术在治疗重度炎性关节病中的应用及疗效。
2008年9月至2015年9月，对31例重度炎性关节病患者行双侧全髋关节置换术和全膝关节置换术。31例中，男22例，女9例，平均年龄30岁（20～41岁）；类风湿关节炎15例，强直性脊柱炎16例，平均发病年龄14岁（5～28岁）；11例观察到4个关节强直，2例观察到3个关节强直，6例观察到2个关节强直，1例观察到1个关节强直，11例无关节强直。术前髋关节活动度（ROM）值为（17.82±28.18）°，膝关节ROM值评分为（26.45±30.18）°；髋关节Harris评分为29.64±11.58，特种外科医院（HSS）评分为27.07±11.04。根据病因和关节强直情况对患者进行分组并比较。
1例行一期置换术，22例行二期置换术，7例行三期置换术，1例行四期置换术。总手术时间为325～776分钟；总失血量为900～3900毫升；总输血量为2220～8070毫升；总住院时间为21～65天。对患者随访12～94个月（平均51个月）。末次随访时髋关节和膝关节ROM值、Harris评分和HSS评分与术前相比均显著改善（<0.05）。主观满意度为优16例，良10例，差5例。2例（3膝）发生假体周围感染，3例（6膝）发生关节僵硬，1例（1膝）发生关节不稳，2例下肢长度差异>2厘米，1例（1膝）发生10°屈曲畸形。强直性脊柱炎患者和类风湿关节炎患者末次随访时髋关节和膝关节ROM值、Harris评分和HSS评分差异无统计学意义（>0.05）。有关节强直患者的髋关节和膝关节ROM值显著低于无关节强直患者（<0.05）；有关节强直患者的Harris评分和HSS评分低于无关节强直患者，但差异无统计学意义（>0.05）。
双侧髋膝关节置换术联合应用是治疗炎性关节病所致重度下肢畸形、关节疼痛及生活质量低下的有效方法。然而，术后假体周围感染和膝关节僵硬是影响手术疗效的重要并发症。
