加速康复外科理念下全膝关节置换治疗类风湿关节炎与骨关节炎患者的临床疗效

doi:10.6040/j.issn.1671-7554.0.2024.0437

摘要/Abstract

摘要： 目的在加速康复外科(enhanced recovery after surgery, ERAS)理念下,比较终末期类风湿关节炎(rheumatoid arthritis, RA)和骨关节炎(osteoarthritis, OA)接受全膝关节置换(total knee arthroplasty, TKA)术后的早期并发症及临床效果。方法回顾性分析山东第一医科大学第一附属医院骨关节运动医学科96例TKA患者的临床资料,将患者分为RA组(n=25)和OA组(n=71)。比较两组患者术中和术后失血量、贫血发生率、浅表及深部感染等术后并发症指标,并采用术后1年的遗忘膝评分(forgotten joint score, FJS-12)量表评估患者的早期临床效果。结果 RA组术后发生中重度贫血的比例高于OA组［9(36.0%)vs. 11(15.5%),P=0.030］;两组患者术中、术后及总出血量差异无统计学意义(P>0.05)。两组患者在术后发生深静脉血栓、肺栓塞、浅表及深部感染以及90 d再入院等并发症方面差异无统计学意义(P>0.05)。RA组术后1年FJS-12评分低于OA组［(71.28±13.45)分 vs.(77.59±10.10)分,P=0.016］,OA组患者遗忘膝比例高于RA组［1(4.0%)vs. 17(23.9%),P=0.035］,但两组通过率无明显差异。结论在ERAS理念下,RA患者术后中重度贫血发生率和住院时间高于OA患者,OA患者术后易获得遗忘膝。关节外科医生应重视纠正RA患者术前贫血,不断完善此类患者的ERAS方案。

关键词: 类风湿关节炎, 骨关节炎, 全膝关节置换, 加速康复外科, 遗忘膝评分

Abstract: Objective To compare the early complications and clinical outcomes of total knee arthroplasty(TKA)for end-stage rheumatoid arthritis(RA)and osteoarthritis(OA)under the concept of enhanced recovery after surgery(ERAS). Methods A retrospective analysis was conducted on the clinical data of 96 patients with TKA in the Department of Joint and Sports Medicine at the First Affiliated Hospital of Shandong First Medical University. The patients were divided into RA group(n=25)and OA group(n=71). The intraoperative and postoperative blood loss, incidence of anemia, and postoperative complications such as superficial and deep infections were compared between the two groups. The early clinical outcomes of the patients were evaluated using the Forgotten Joint Score-12(FJS-12)at 1 year postoperatively. Results The proportion of moderate and severe anemia postoperatively was higher in the RA group compared to the OA group ［9(36.0%)vs. 11(15.5%), P=0.030］. There were no significant differences in intraoperative, postoperative, and total blood loss between the two groups(P>0.05). No statistically significant differences were observed in the occurrence of complications such as deep venous thrombosis, pulmonary embolism, superficial and deep infections, and rehospitalization within 90 days postoperatively between the two groups(P>0.05). The FJS-12 score at 1 year postoperatively was lower in the RA group compared to the OA group［(71.28±13.45)vs.(77.59±10.10, P=0.016)］, and the proportion of patients achieving a forgotten joint status was higher in the OA group compared to the RA group ［1(4.0%)vs. 17(23.9%), P=0.035］. However, there was no significant difference in the passing rate between the two groups. Conclusion Under the ERAS concept, the incidence of moderate and severe anemia and length of stay in RA patients after TKA are higher than those of OA patients, while OA patients are more likely to experience a forgotten knee after TKA. Orthopedic surgeons should focus on correcting preoperative anemia in RA patients and continuously optimize the ERAS protocol for these patients.

Key words: Rheumatoid, Osteoarthritis, Total knee arthroplasty, Enhanced recovery after surgery, Forgotten knee score

中图分类号:

R684.3

姜任东,赵建莉,时超,贺业腾,袁振. 加速康复外科理念下全膝关节置换治疗类风湿关节炎与骨关节炎患者的临床疗效[J]. 山东大学学报 (医学版), 2024, 62(10): 62-67.

JIANG Rendong, ZHAO Jianli, SHI Chao, HE Yeteng, YUAN Zhen. Clinical outcomes comparison of total knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis under the concept of enhanced recovery after surgery[J]. Journal of Shandong University (Health Sciences), 2024, 62(10): 62-67.

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