同期与分期双侧全膝关节置换治疗膝骨关节炎的疗效比较  

Therapeutic efficacy comparison of bilateral total knee arthroplasty in treating knee osteoarthritis with synchronization and staging

作　　者：隋聪[1] 刘德宝[1] SUI Cong, LIU De-bao(Dept of Orthopaedics, the First Affiliated Hospital of Anhui Medical University, Hefei ,Anhui 230022, China)

机构地区：[1]安徽医科大学第一附属医院骨科,安徽合肥230022

出　　处：《临床骨科杂志》2018年第4期463-465,469,共4页Journal of Clinical Orthopaedics

摘　　要：目的比较同期与分期双侧全膝关节置换术(TKA)治疗膝骨关节炎(KOA)的临床疗效。方法将初次行TKA治疗的98例KOA患者作为研究对象,采用随机数字法分为同期组(同期行双侧TKA)和分期组(分期行双侧TKA),每组49例。观察比较两组患者手术时间、手术费用、住院时间、引流量、输血量、术后失血量、血红蛋白变化值(ΔHb)、红细胞压积变化值(ΔHCT)及并发症等指标;采用HSS评分评价两组临床疗效和功能恢复情况。结果患者均获得12个月的随访。手术费用、住院时间、手术时间同期组低于分期组,差异均有统计学意义(P<0.05)。引流量、术后失血量、输血量、ΔHb、ΔHCT指标同期组多(高)于分期组,差异均有统计学意义(P<0.05)。并发症发生率同期组(8例,16.3%)高于分期组(3例,6.1%),但差异无统计学意义(P>0.05)。术后1、3、6、12个月HSS评分两组比较差异无统计学意义(P>0.05)。术后12个月膝关节活动度、屈曲挛缩度和疼痛VAS评分两组比较差异无统计学意义(P>0.05)。结论同期或分期双侧TKA治疗中老年KOA均能恢复相同的膝关节功能,疗效相当。Objective To compare the clinical efficacy of bilateral total knee arthroplasty（ TKA） in the treatment of knee osteoarthritis（ KOA） with two kinds of methods（ synchronous bilateral TKA and staged bilateral TKA）. Methods A total of 98 KOA patients treated with TKA were randomly divided into two groups（ synchronous bilateral TKA and staged bilateral TKA）,with 49 cases in each group. Two groups were observed the operation time,operation cost,hospitalization time,drainage volume,blood transfusion,postoperative blood loss,hemoglobin change value（ ΔHb）,hematocrit product change（ ΔHCT） and complications. Postoperative HSS score was used to evaluate the clinical efficacy and functional recovery of KOA treated with bilateral TKA during the same period or stage. Results All patients were followed up for 12 months. The cost of operation,length of hospital stay,total operation time and the bilateral group were significantly lower than those of the bilateral group at the same period（ P 0. 05）. The total flow rate and postoperative blood loss,blood transfusion volume,ΔHb,ΔHCT bilateral group were higher than the same period stage bilateral group,differences were statistically significant（ P 0. 05）. Complications of bilateral perioperative complications（ 16. 3% in 8 cases） were higher than those in the two groups（ 6. 1% in 3 cases） in the same period,but the difference was not statistically significant（ P 0. 05）. There was no significant difference in the HSS score at 1,3,6 and 12 months after operation between the two groups（ P 0. 05）. There was no significant difference in knee mobility,flexion contracture and pain score between the two groups at 12 months postoperative follow-up（ P 0. 05）. Conclusions The same period or staged bilateral TKA for treatment of middle-aged and elderly KOA can restore the same knee function,the effect is same.

关 键 词：骨关节炎 膝 同期双侧全膝关节置换 分期双侧全膝关节置换 

分 类 号：R684.3[医药卫生—骨科学] R687.4[医药卫生—外科学]