严重骨质疏松患者全膝关节置换术疗效分析

目的:探讨严重骨质疏松患者在进行人工全膝关节置换术时的特点和围手术期处理方法。方法:2005年至2007年期间,我科进行伴有严重骨质疏松症的人工全膝关节置换术患者共计36例41膝,其中单膝关节置换31例,双膝置换5例。所有病例入院前均采用双光能X线骨密度仪(DEXA)检测骨密度。所有病例均采用后稳定型膝关节假体。患者在术前给予钙尔奇D片及鲑鱼降钙素等抗骨质疏松治疗1月,术后继续给予抗骨质疏松治疗2~3月。结果:术后切口均一期愈合,无并发症。所有病例随访时间36~60个月,平均49个月。膝关节功能评分(HSS评分法)术前平均为37.2±6.4分,术后平均评分94.6±8.8分,随访期间未见假体早期松动影像学改变,骨密度复查较术前有明显改善。结论:对于伴有严重骨质疏松的病例,骨质已受到不同程度的破坏,进行假体选择的个体化,手术操作的精细化以及术后康复治疗具体化等对临床疗效至关重要。

Total Knee Replacement for Patients with Severe Osteoporosis

Objective: To discuss the treating effects and perioperative curing methods of total knee replacement on serious osteoporosis patients. Methods: From 2005 to 2007 we treated 36 osteoarthritis patients by total knee joint replacement. The bone mineral density (BMD) of all these patients was measured by dual energy X-ray absorptiometry (DEXA). All the patients were treated by legacyposterior stabilization Flex knee arthroplasty (LPS-FKA). Anti-osteoporosis drugs were used one month before and two to three months later of the operation. Results: The results of short term follow-up showed that all the cuts were A healing and all the fixation were stable, the compression symptoms were relieve or vanish. The function of the knee joint was measured by HSS score. Pre-operation the average score of the patients was 37.2±6.4, and post-operation the score was raised to 94.6±8.8. The BMD of all the patients was also improved. Conclusions: Due to the poor stability of the damaged bone quality, the individual prosthesis, careful operation and specific rehabilitation should be emphasized, when serious osteoporosis patients were treated.