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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 clinical effect and prognosis of patients with severe osteoporosis after bilateral knee arthroplasty and to summarize the effective perioperative rehabilitation measures for clinical reference. Methods The clinical data of 32 patients with severe osteoporosis who received manual knee arthroplasty between January 2011 and December 2014 in Taizhou First People’s Hospital were retrospectively analyzed. Including 12 males and 20 females; average age (64.5 ± 6.5) years; average duration of 5.8 years. Surgery by the two chief physician surgeon, according to the knee joint replacement routine steps to complete. Postoperative patients with comprehensive rehabilitation intervention. ROM, HSS score, bone mineral density and quality of life were compared before and after surgery. Results The operation was successful and no intraoperative complications were found. One patient had peroneal common nerve paralysis in one knee and one knee deviation in 2 patients. All patients returned to normal after symptomatic treatment. Prosthesis installation effect is good. After the intervention by comprehensive rehabilitation measures, patients recovered well. After 6 months of follow-up, the indexes of patients were significantly improved compared with those before surgery, and the scores of quality of life and HSS were significantly improved (P <0.05). There was no statistical difference in BMD and ROM between the two groups Significance (P> 0.05). Patients are well tolerated with osteoporosis drugs. Up to the end of follow-up of this study, the patient’s limb function recovered well and the pain was relieved. All patients could walk independently for 50-100 m without external force. There were no long-term complications such as loosening of the prosthesis, rupture and cardiovascular and cerebrovascular accidents. Conclusion Simultaneous double knee replacement requires a comprehensive evaluation of the patient’s specific condition before and after treatment. Most patients with severe osteoporosis can obtain good short-term clinical results and prognosis. Individualized rehabilitation programs for each patient postoperatively consolidate Surgical effect, improve the rehabilitation effect has important clinical value.