任远中;王英振;李涛;余永波;虞丁柱;姜雅萍;

• 1:青岛大学医学部
• 2:青岛大学附属医院关节外科
• 3:青岛大学附属医院口腔科

摘要(Abstract)：

[目的]评价全膝关节置换术(TKA)治疗膝骨关节炎(osteoarthritis, OA)合并帕金森病(Parkinsons disease, PD)的临床效果,探讨TKA治疗在OA合并PD患者人群中的有效性与安全性。[方法]回顾分析2012年1月1日～2018年11月1于本院行TKA治疗合并PD的OA患者,统计其性别、年龄、BMI、术前基础疾病等基本信息,采用国际Hoehn—Yahr分级对帕金森病患者病情进行评估,采用KSS评分对膝关节术前术后的活动度、疼痛及功能进行评价。[结果]本组男4例,女9例,就诊时平均年龄(69.23±5.93)岁。所有患者切口均I期愈合,无血栓、感染等局部和全身并发症发生。患者疼痛程度均较前明显减轻或消失。术后患者Hoehn-Yahr分级维持原等级。13例患者均获得随访,时间12～54个月,平均23.4个月。末次随访时,其中轻度疼痛2例,中度3例,无重度疼痛者。X线片未见松动迹象,末次随访KSS评分比术前显著提高,其中KSS活动度评分、KSS疼痛相关评分、KSS功能评分分别为26.69、47.38、44.83,与术前相比差异有统计学意义(P<0.05)。与术前对比,KSS评分中疼痛较活动度及功能提高更明显。[结论]帕金森合并骨关节炎患者,在相关科室会诊并控制好PD病情基础上,人工全膝关节置换术是一种安全有效的方法。TKA可以明显缓解疼痛,改善步态,患者满意度较高。

关键词(KeyWords)： 膝关节;帕金森病;骨关节炎;全膝关节置换

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金资助项目(编号:81802151);; 山东省自然科学基金资助项目(编号:ZR2016HQ05;ZR2017BH089);; 中国博士后科学基金面上资助(编号:2018M642616)

作者(Author): 任远中;王英振;李涛;余永波;虞丁柱;姜雅萍;

Email:

DOI:

参考文献(References)：

• [1]Bijlsma JW,Berenbaum F,Lafeber FP.Osteoarthritis:an update with relevance for clinical practice[J].Lancet,2011,9783:2115-2126.
• [2]陈伟贤,张赛.帕金森病的诊断和治疗[J].中华全科医学,2015,5:692-693.
• [3]刘明玺,张志强.帕金森病合并膝关节骨关节炎行人工全膝关节置换的研究进展[J].中华骨与关节外科杂志,2018,1:73-77.
• [4]中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版)[J].中华骨科杂志,2018,12:705-715.
• [5]Niinimaki T,Eskelinen A,Makela K,et al.Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship:a 27-year finnish registry study[J].Clin Orthop,2014,5:1496-1501.
• [6]Hoehn MM,Yahr MD.Parkinsonism:onset,progression,and mortality.1967[J].Neurology,2001,10(Suppl 3):S11-S26.
• [7]Goetz CG,Poewe W,Rascol O,et al.Movement disorder society task force report on the hoehn and yahr staging scale:status and recommendations[J].Mov Disord,2004,9:1020-1028.
• [8]Oni OO,Mackenney RP.Total Knee replacement in patients with parkinson's disease[J].J Bone Joint Surg Br,1985,3:424-425.
• [9]Wong EH,Oh LJ,Parker DA.Outcomes of primary total knee arthroplasty in patients with Parkinson's disease[J].J Arthroplasty,2018,6:1745-1748.
• [10]Vince KG,Insall JN,Bannerman CE.Total knee arthroplasty in the patient with Parkinson's disease[J].J Bone Joint Surg Br,1989,1:51-54.
• [11]Duffy GP,Trousdale RT.Total knee arthroplasty in patients with Parkinson's disease[J].J Arthroplasty,1996,8:899-904.
• [12]Ashraf M,Priyavadhana S,Sambandam SN,et al.Total knee arthroplasty in patients with Parkinson's disease-a critical analysis of available evidence[J].Open Orthop J,2017:1087-1093.
• [13]蔡思逸,朱威,翁习生,等.全膝关节置换术治疗合并帕金森病严重骨关节炎患者的并发症特点和临床疗效分析[J].中华骨与关节外科杂志,2015,1:38-43.
• [14]孙启才,茹选良,宋柏杉,等.全膝关节置换术治疗合并帕金森病骨关节炎患者的中期随访和临床疗效分析[J].中国骨伤,2018,3:257-262.
• [15]Tinning CG,Cochrane LA,Singer BR.Primary total knee arthroplasty in patients with Parkinson's disease:analysis of outcomes[J].Acta Orthop Belgica,2013,3:301-306.
• [16]Fast A,Mendelsohn E,Sosner J.Total knee arthroplasty in Parkinson's disease[J].Arch Phys Med Rehabil,1994,11:1269-1270.
• [17]Mehta S,Vankleunen JP,Booth RE,et al.Total knee arthroplasty in patients with Parkinson's disease:impact of early postoperative neurologic intervention[J].Am J Orthop(Belle Mead NJ),2008,10:513-516.
• [18]孙卫平,邹华强,王善超.双侧人工膝关节同期置换和分期置换的近期疗效比较[J].中国矫形外科杂志,2018,21:1942-1946.
• [19]Newman JM,Sodhi N,Wilhelm AB,et al.Parkinson's disease increases the risk of perioperative complications after total knee arthroplasty:a nationwide database study[J].Knee Surg Sports Traumatol Arthrosc,2018:1-10.2019-01-02 2019-02-01