摘要
目的探讨严重骨质疏松症患者经双侧膝关节置换术治疗后的近期临床效果及预后,总结可供临床参照的围术期的有效康复措施。方法回顾性分析台州市第一人民医院2011年1月—2014年12月接受双膝关节人工置换术的32例严重骨质疏松症患者的临床资料。其中男性12例,女性20例;平均年龄(64.5±6.5)岁;平均病程5.8年。手术由2位副主任医师主刀,按膝关节置换术的常规步骤完成。术后对患者经综合康复措施干预。比较患者手术前后的关节活动度ROM、HSS评分,骨密度和生活质量。结果患者手术顺利,术中无并发症,术后1例1膝出现腓总神经麻痹,1例2膝关节活动度偏差,均经对症处理后恢复正常。假体安装效果良好。术后经综合康复措施干预,患者康复均良好。术后6个月随访时,患者各项指标与术前比较,生活质量评分、HSS评分有显著改善,差异均有统计学意义(P<0.05);骨密度、ROM关节活动度的差异无统计学意义(P>0.05)。患者对抗骨质疏松药物耐受性良好。截至本研究随访结束,患者的患肢功能恢复良好、疼痛明显减轻,患者均可不借助外力独立行走50~100 m。未发生假体松动、断裂和心脑血管意外等远期并发症。结论双膝关节同时置换术前需综合评价患者的具体病情,对大部分严重骨质疏松患者而言可以获得良好的近期临床效果和预后,其中术后针对每一患者的个体化康复计划对于巩固手术效果、提高康复效果具有重要的临床价值。
Objective To investigate the short-term clinical result and prognosis of patients with severe osteoporosis after bilateral knee joint replacement. Methods The clinical data of 32 cases of severe osteoporosis undergoing bilateral knee joint replacement in our hospital from January, 2011 to December, 2014 were analyzed retrospectively. Among the pa- tients, 12 cases were male and 20 were female. Mean age was （64.5 ± 6.5 ） years old. Mean course of disease was 5.8 years. All patients were completed the operation according to the routine procedures of knee arthroplasty. After the opera- tion,the comprehensive rehabilitation measures were performed. The range of motion （ ROM ）, HSS scores, bone density and quality of life of patients before and after the surgery were compared. Results All operations were successful;there were no complications during the operation. After the operation, one case （1 knee） was with peroneal nerve paralysis, one case （2 knees） was with poor range of motion, both those cases recovered after the symptomatic treatment. The knee pros- thesis was implanted satisfactorily. All patients were with good rehabilitation through comprehensive rehabilitation inter- vention. 6 month follow-up showed that the quality of life score and HSS score were significantly improved （ P 〈 0.05 ）, but bone density and ROM did not（ P 〉 0.05 ）. The osteoporosis drugs were well tolerated by patients. At the end of this stud- y, the limb function of patients recovered well, the pain was significantly reduced, and all patients achieved independent walking ability（50 -100 m） without using external force. No long-term complications such as prosthesis loosening, frac- ture, and cardiac and cerebral vascular accident occurred. Conclusion The comprehensive evaluation of the patient＇ s condition before the bilateral knee joint replacement surgery was necessary. The bilateral knee joint replacement for pa- tients with severe osteoporosis can reach a satisfactory short-term clinical result and
出处
《中华全科医学》
2017年第3期437-439,486,共4页
Chinese Journal of General Practice
关键词
骨质疏松
膝关节置换术
综合康复措施
临床效果
Osteoporosis
Knee joint replacement
Comprehensive rehabilitation measures
Clinical effect
