摘要
类风湿性关节炎（rheumatoid arthritis,RA）是一种以侵蚀性炎症性滑膜炎为特征,可造成关节软骨和骨质破坏,除关节外还可涉及全身其它组织器官的慢性、自身免疫性疾病,晚期可导致严重的关节疼痛、畸形。特别是负重的髋膝等大关节受累时患者的生活质量明显下降。全膝关节置换术（total knee arthroplasty,TKA）是减轻RA患者疼痛、改善患肢功能,提高其生活质量的有效方法,但是RA患者较骨性关节炎患者有其特殊的临床及病理特征，如常合并全身其它系统疾病，术前实验室检查中常见炎症性指标增高，所服用治疗药物对手术的安全性等。
Total knee arthroplasty（ TKA） is developing. Rheumatoid arthritis（ RA） patients, whose knee function is severely affected, have obtained good effects. RA can not only affect the joints, but a systemic and multisystematic disease. When involving the cervical spine, RA can cause upper cervical instability. It is essential to pay more attention to asymptomatic patients, so as to select appropriate treatment measures. Preoperative heart function rating can assess the risk of surgery and the tolerance of patients. The pulmonary injury often slacks up lung functions too. RA patients also have higher prevalence of oral or periodontal diseases, which is related with artificial joint infection after the surgery. Anemia can lead to increased risk of infection and delayed wound healing. So for each body the comprehensive and systematic preoperative evaluation is necessary. In addition, degree of preoperative rheumatoid arthritis and inflammatory indexes such as blood sedimentation, c-reactive protein level are of controversy. The use of clinical drugs to relieve symptoms before surgery or not is worth the attention of orthopedic surgeons. Patients with long-term drug therapy, such as traditional DMARDs and biological agents, cortisol, have the risk of infection after the knee replacement. Researches on biological agents in the treatment of rheumatoid arthritis are being conducted in recent years. Foreigners also put forward the guide on the perioperative use of biological agents. Detailed preoperative evaluation and multidisciplinary cooperation are necessary to reduce the risk of surgery.
出处
《中国骨与关节杂志》
CAS
2016年第2期153-157,共5页
Chinese Journal of Bone and Joint
