同期与分期双侧全髋置换术临床比较分析  

One-stage bilateral total hip arthroplasty versus two-stage bilateral total hip arthroplasty

作　　者：曹乐[1] 张先龙[1] 邹国友[1] 顾剑华[1] 蒋垚[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《临床骨科杂志》2008年第6期502-505,共4页Journal of Clinical Orthopaedics

摘　　要：目的比较同期与分期双侧全髋置换术围手术期安全性及相关临床指标。方法同期双侧全髋置换术(THAⅠ组)74例(148髋),分期双侧全髋置换术(THAⅡ组)54例(108髋),比较两组术前合并症、术后并发症、手术时间、总失血量、输血量、手术前后Harris评分、血红蛋白、血细胞比容、住院天数、总费用等临床指标。结果两组性别、年龄、术前合并症、手术前后Harris评分、血红蛋白、血细胞比容比较差异均无显著性(P>0.05)。THAⅠ组平均手术时间(135.7±33.0)min、总失血量(1378.6±571.7)ml、输血量(575.8±582.6)ml,THAⅡ组平均手术时间(161±46.1)min、总失血量(1589.5±628.0)ml、输血量(544.6±582.6)ml,两组差异无显著性(P>0.05)。THAⅠ组平均住院天数(15.7±4.1)d、总费用(69603±27054.7)元,THAⅡ组平均住院天数(29.2±10.8)d、总费用(107169±51697.1)元,两组差异有显著性(P<0.01)。THAⅠ组神经系统并发症(P=0.017)、心血管系统并发症(P=0.012)发生率比THAⅡ组高,差异具有显著性;其他系统并发症差异无显著性(P>0.05)。结论同期双侧髋关节置换术是安全有效的手术方案,并且能够降低住院天数、减少住院费用。Objective To compare the safety and perioperative clinical parameters in consecutive patients undergoing one-stage or two-stage bilateral total hip arthroptasty. Methods 128 patients underwent bilateral total hip arthroplasty, of which 74 patients （ 148 hips） were done as a one-stage procedure（ THAⅠ ） , whereas 54 patients （ 108 hips） were done in two-stage（ THA Ⅱ ）. The pre-existing diseases, postoperative complications, operative time, total blood loss, transfusion requirement, preoperative and postoperative Harris hip score and henmglobin and hemiatocrit, hospital stay, total expenses were compared. Results No significant differences were found in age, gender, pre-existing diseases, preoperative and postoperative Harris hip score and hemoglobin and hematocrit （ P 〉 0. 05 ）. There were no significant differences in mean operative tilne （THA Ⅰ 135.7± 33.0 minutes, THA Ⅱ 161 ± 46. 1 minutes）, total blood loss（ THAⅠ 1378.6 ± 571.7 ml, THA Ⅱ 1589. 5 ± 628. 0 ml） , transfusion（ THA Ⅰ 575.8 ± 582.6 ml, THA Ⅱ 544. 6 ± 582.6 ml） （P 〉 0. 05 ）. The mean hospital＇stay were 15.7 ± 4. 1 days in THAI group and 29.2 ± 10. 8 days in THA Ⅱ group, and total expenses were 69 603 ±27054. 7 RMB yuan in THAⅠ group and 107 169 ±51697. 1 RMB vuan in THA Ⅱ group, both indexes had extremely significant differences（P 〈0. 01 ）. The rates of neurological complications（ P = 0. 017 ） and cardiovascular complications （P = 0. 012 ） were significantly higher in THAI group than in THA Ⅱ group. The rates of other complications had no significant differences（ P 〉 0. 05）. Conclusions One-stage bilateral total hip arthroplasty is safe and efficient, and it＇ s cheaper and spends less time in hospital. Meanwhile, the pre-existing diseases should be treated, and the high-risk patients should be performed of the operative risk and possibility of intra-operative change into two-stage procedure.

关 键 词：双侧全髋置换术 同期 分期 病例对照研究 

分 类 号：R687.3[医药卫生—骨科学] R687.4[医药卫生—外科学]