《中国组织工程研究》 Chinese Journal of Tissue Engineering Research1337·研究原著·周祺，男，1985年生，汉族，江苏省常州市人，硕士，主治医师。
通讯作者：瞿玉兴，博士，主任医师。
常州市中医医院骨一科，江苏省常州市 213000文献标识码:A来搞时间：2019-02-23 送审时间：2019-03-05 采用时间：2019-05-23 在线时间：2019-10-10Zhou Qi, Master, Attending physician, First Department of Orthopedics, Changzhou Traditional Chinese Medicine Hospital, Changzhou 213000, Jiangsu Province, ChinaCorresponding author: Qu Yuxing, MD, Chief physician, First Department of Orthopedics, Changzhou Traditional Chinese Medicine Hospital, Changzhou 213000, Jiangsu Province, China全膝关节置换治疗类风湿关节炎：关节功能及相关生化指标的变化周 祺，高 益，魏 康，黎 俊，徐建达，蒋 阳，瞿玉兴(常州市中医医院骨一科，江苏省常州市 213000) DOI:10.3969/j.issn.2095-4344.2441 ORCID: 0000-0003-1810-3780(周祺)文章快速阅读：文题释义：类风湿关节炎早期表现：滑膜炎、软骨破坏，不常累及膝关节，但65%-75%的患者最终将累及双侧膝关节，90%以上的慢性类风湿关节炎患者出现膝关节受累。
关节活动度：指关节运动时所通过的运动弧或转动的角度。
摘要背景：以往有关全膝关节置换治疗类风湿关节炎临床疗效的研究报道较多，而关于全膝关节置换对类风湿关节炎患者关节功能及相关生化指标的影响研究较少，因此需要更多的临床证据支持。
目的：分析全膝关节置换治疗类风湿关节炎对患者关节功能及相关生化指标的影响。
方法：选取接受全膝关节置换的患者64例(64膝)，回顾性分析患者的临床资料。
对比分析术前与术后1年患者美国特种外科医生膝关节评分、膝关节活动度及生活质量评分结果，检测患者C -反应蛋白、类风湿因子及血沉等生化指标的变化，并记录患者术后1个月并发症发生情况。
该研究已获得常州市中医医院医学伦理委员会批准，所有患者均签署知情同意书。
结果与结论：①与术前相比，患者术后1年HSS 评分、膝关节活动度、生活质量评分明显升高(P < 0.01)，C -反应蛋白、类风湿因子及血沉水平明显降低(P < 0.01)；②术后1例患者发生感染，2例患者出现下肢深静脉血栓，经对症治疗后得到缓解。
结果证实，全膝关节置换对类风湿关节炎有较好的临床效果，可改善患者膝关节功能，降低C -反应蛋白、类风湿因子及血沉水平，具有良好的安全性。
关键词：全膝关节置换；类风湿；关节炎；C-反应蛋白；类风湿因子；血沉；骨关节植入物；人工假体；感染；下肢深静脉血栓中图分类号：R459.9；R605；R684Total knee arthroplasty for rheumatoid arthritis: knee function and biochemical index changesZhou Qi, Gao Yi, Wei Kang, Li Jun, Xu Jianda, Jiang Yang, Qu Yuxing (First Department of Orthopedics, Changzhou Traditional Chinese Medicine Hospital, Changzhou 213000, Jiangsu Province, China)AbstractBACKGROUND: Previous studies on the clinical efficacy of total knee arthroplasty in the treatment ofrheumatoid arthritis have been reported, but the effects of total knee arthroplasty on joint function and related biochemical parameters in patients with rheumatoid arthritis are little reported. Thereafter, more clinical evidence is needed.OBJECTIVE: To analyze the effect of total knee arthroplasty on joint function and related biochemical indicators in patients with rheumatoid arthritis.METHODS: Clinical data of 64 patients with 64 knees who underwent total knee arthroplasty were周祺，高益，魏康，黎俊，徐建达，蒋阳，瞿玉兴. 全膝关节置换治疗类风湿关节炎：关节功能及相关生化指标的变化[J]. 中国组织工程研究，2020，24(9):1337-1341. DOI:10.3969/j.issn.2095-4344.24411338retrospectively analyzed. Comparative analysis of Hospital for Special Surgery, range of motion of the knee joint and quality of life scores before and 1 year after surgery was conducted. Changes of biochemical indicators such as C-reactive protein, rheumatoid factor anderythrocyte sedimentation rate were detected. The incidence of complications at 1 month after surgery was recorded. The study was approved by the Ethical Committee of Changzhou Traditional Chinese Medicine Hospital, and all patients signed the informed consents.RESULTS AND CONCLUSION: (1) Compared with the baseline levels, the Hospital for Special Surgery score, range of motion of the knee joint and quality of life scores at 1 year after surgery was significantly increased (P < 0.01), and the levels of C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate were significantly decreased (P < 0.01). (2) One patient developed infection and two patientsdeveloped deep vein thrombosis of the lower extremity, which was relieved after symptomatic treatment. These results imply that total knee arthroplasty has a good clinical effect on rheumatoid arthritis, which can improve knee function and reduce the levels of C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate, and has good safety.Key words : total knee replacement; rheumatoid; arthritis; C-reactive protein; rheumatoid factor; erythrocyte sedimentation; bone and joint implant; artificial prosthesis; infection; deep venous thrombosis of lower extremity0 引言 Introduction类风湿关节炎是以关节炎性反应为表现的自身免疫性疾病，病因尚不完全明确，此病迁延难愈，发病早期病情发展迅速，病变呈进行性发展，破坏关节软骨，使患者关节功能受到影响，致残率高，中年女性为多发人群[1]。
类风湿关节炎病情发展迅速或晚期患者常因膝关节疼痛肿胀无法正常行走，使得关节周围肌肉萎缩，导致膝关节功能减退，给患者的生活造成极大影响。
临床治疗类风湿关节炎以患肢固定、激素、抗炎药及免疫制剂等综合疗法为主，但疗效不佳[2]。
近30年来，人工全膝关节置换治疗类风湿关节炎发展迅速，技术日渐完善成熟。
既往研究表明，全膝关节置换可缓解患者膝关节疼痛、矫正畸形及改善关节功能，疗效确切，在临床应用中获得了医生和患者的肯定，逐渐成为治疗类风湿关节炎的有效手段[3-4]。
以往有关全膝关节置换治疗类风湿关节炎的长期临床疗效的研究报道较多，而关于全膝关节置换对类风湿关节炎整体病情活动性的影响研究较少。
文章通过分析全膝关节置换对类风湿关节炎患者关节功能及相关生化指标的影响，评价全膝关节置换对类风湿关节炎整体病情活动性的影响。
1 对象和方法 Subjects and methods1.1 设计 回顾性病例分析。