同期与分期双侧全膝关节置换的对照研究  

Control Study of Simultaneous and Staggered Bilateral Total Knee Arthroplasty

作　　者：梁秋发[1] 刘文松 刘文胜 郑越生 王强[1] 陈胜阳 陈圣龙 

机构地区：[1]佛山科学技术学院门诊部骨科医学院临床医学系,广东佛山528000 [2]广州白云山医院骨科 [3]广州文明微创医院骨科

出　　处：《中南医学科学杂志》2012年第4期384-387,共4页Medical Science Journal of Central South China

摘　　要：目的比较同期双侧全膝关节置换(TKA)和分期双侧TKA的疗效和安全性。方法回顾性分析2006～2010年因双膝原发性骨关节炎接受双膝关节表面置换手术且随访资料满1年的患者67例。按双侧膝关节置换手术是否分期进行分为同期手术组和分期手术组,分别比较两组患者术前并发症、治疗因素和治疗效果的差异。术前因素包括年龄、体质指数、病程和术前合并症;治疗因素包括总住院时间、总手术时间、伤口总引流量、总输血量;疗效判断采用术前、术后1年时的HSS评分及其改善程度作为观察指标,并统计并发症的种类及例数。结果同期手术患者45例,分期手术患者22例。分期手术组术前合并症率明显高于同期手术组(P<0.05),但两组年龄、体质指数、病程比较差异无显著性(P>0.05)。分期手术组总住院时间明显长于同期手术组(P<0.01),但同期手术组总输血量明显多于分期手术组(P<0.01),两组总手术时间、总引流量比较差异无显著性(P>0.05)。两组术前、术后1年时HSS评分比较差异无显著性(P>0.05)。两组均有小腿肌间静脉发生血栓及伤口延迟愈合,但两组发病率比较差异无显著性(P>0.05)。两组均无严重并发症发生,住院死亡率均为零。结论在合理选择患者并进行完善的术前准备下,同期双膝TKA和分期双膝TKA具有相同的临床效果和安全性。Objective To compare the clinical effectiveness and safty between simultaneous and staggered bilateral total knee arthroplasty （TKA）. Methods We retrospectively analyzed 67 patients with prmiary osteoarthritis of both knee joints who received bilateral TKA and follow - up for 1 years. These patients were grouped into smiultaneous group and staggered group based on the procedures. The age, body weight index （BWI） , years lived with disorder （YLD）, preoperative co - morbidity, total hospitalization time, total operation time, total drainage volume, total blood transfusion volume, preoperative Hospital for Special Surgery score（ HSS）, post -operative HSS score （1 year） , complications, and its ratio were analyzed with t test. Results The simultaneous group included 45 cases （16 males and 29 females） and the staggered group included 22 cases （ 8 males and 14 females）. The pre - operative co - morbidity rate was significantly higher in the staggered group than in the simultaneous group, while no such significant difference existed in terms of age, BWI, and YLD （ P 〉 0.05 ） . The total hospitalization time of staggered group was significantly longer than that of the simuhaneous group,while the total blood transfusion volume was significantly less （P 〈 0. 01 ）. The total operation time, and total drainage volume were not significantly different between two groups （ P 〉 0.05 ）. The HSS scores before operation and 1 year after operation were not significantly different between two groups （ P 〉 0.05 ）. The wound complication rate was higher in the simultaneous group than that in the staggered group. Thromboembolism events occurred in calfmuscular veins in both groupswith similar incidences. No patients suffered from severe complications or died during hospital stay. Conclusion The clinical effectiveness and salty of simultaneous bilateral TKA is similar to that of staggered bilateral TKA with carefully selecting patient and pre-operative preparation.

关 键 词：全膝关节置换 双侧 同期手术 分期手术 

分 类 号：R683.42[医药卫生—骨科学]