同期与分期行双侧全膝关节置换术对双侧膝骨关节炎患者围手术期失血量及短期疗效的影响  

The effect of bilateral total knee arthroplasty at the same time and in stages on perioperative blood loss and shortterm efficacy in patients with bilateral knee osteoarthritis

作　　者：杨天翔 张博文 张晋宁 程萌旗[3] 陈德胜 YANG Tianxiang;ZHANG Bowen;ZHANG Jinning;CHENG Mengqi;CHEN Desheng(Department of Orthopedic,People's Hospital of Ningxia Hui Autonomous Region,Yinchuan,Ningxia,750002,China;School of Clinical Medicine,Ningxia Medical University,Yinchuan,Ningxia,750004,China;Department of Joint Surgery,the Sixth People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai,200233,China)

机构地区：[1]宁夏回族自治区人民医院骨科,宁夏银川750002 [2]宁夏医科大学临床医学院,宁夏银川750004 [3]上海交通大学附属第六人民医院关节外科,上海200233

出　　处：《当代医学》2023年第27期10-14,共5页Contemporary Medicine

基　　金：国家自然科学基金(82060408);宁夏科技厅重点研发项目(2021BEG03049);宁夏留学人员创新创业团队项目(NRS2021-5);宁夏回族自治区人民医院宁夏临床医学研究所开放课题(〔2022〕159号)。

摘　　要：目的探究同期与分期双侧人工全膝关节置换术(TKA)对双侧膝骨关节炎(KOA)患者围手术期出血量及短期疗效的影响。方法回顾性分析2018年5月至2021年3月宁夏医科大学总医院收治的52例双侧KOA患者作为研究对象,根据手术方式不同分为同期组(n=20)与分期组(n=32)。同期组采用同期双侧TKA治疗,分期组采用分期双侧TKA治疗,比较两组不同时间点血红蛋白(Hb)水平和红细胞压积(Hct)、围手术期指标、手术前后视觉模拟评分法(VAS)、美国特种外科医院(HSS)评分及并发症发生情况等。结果两组Hb、Hct组间、时间、交互比较差异有统计学意义(P<0.05)。术前,两组Hb水平、Hct比较差异无统计学意义;术后第1、3天,两组Hb均低于前一时间点,Hct均小于前一时间点,且同期组Hb低于分期组,Hct小于分期组,差异有统计学意义(P<0.05)。同期组总失血量、隐性失血量、显性失血量均多于分期组,差异有统计学意义(P<0.05);同期组术后有/无深静脉血栓(DVT)发生率及输血率均高于分期组,住院时间短于分期组,住院费用少于分期组,差异有统计学意义(P<0.05);术前,两组VAS、HSS评分比较差异无统计学意义;术后,两组VAS、HSS评分均高于治疗前,且同期组高于分期组,差异有统计学意义(P<0.05)。结论同期行TKA具有较高的有效性和经济性,手术安全性有所下降,术前应排除手术禁忌证,严格选择手术适应证,在保障患者安全的情况下,进行手术治疗。Objective To investigate the effects of bilateral total knee arthroplasty(TKA)at the same time and in stages on perioperative blood loss and short-term efficacy in patients with bilateral knee osteoarthritis(KOA).Methods 52 patients with bilateral KOA admitted to the General Hospital of Ningxia Medical University from May 2018 to March 2021 were retrospectively analyzed and they were divided into the concurrent group(n=20)and the staging group(n=32)according to different surgical methods.The concurrent group was treated with bilateral TKA,and the staging group was treated with stage TKA,the Hemoglobin(Hb)level,red blood cell specific volume(Hct)at different time,perioperative indexes,visual analogue scale(VAS),Hospital for Special Surgery(HSS)score before and after surgery and complications were compared between the two groups.Results There were significant differences in Hb level,Hct between the two groups of group,time points and interaction(P<0.05).Before operation,there were no significant differences in the Hb level and Hct between the two groups;at the 1st,3rd days after surgery,Hb levels of the two groups was lower than the previous time point,Hct was smaller than the previous time point,and Hb in the same period group was lower than the staging group,Hct was smaller than the staging group,the differences were statistically significant(P<0.05).The total blood loss,recessive blood loss and dominant blood loss in the concurrent group were more than those in the staging group,the differences were statistically significant(P<0.05).The incidence of postoperative deep venous thrombosis(DVT)and blood transfusion rates in the concurrent group were higher than those in the staging group,the length of hospital stay was shorter than that in the staging group,and the hospitalization cost was less than that in the staging group,the differences were statistically significant(P<0.05).Before operation,there was no significant difference in VAS score and HSS score between the two groups;after operation,the VAS and HSS scor

关 键 词：膝关节骨性关节炎 同期全膝关节置换术 分期全膝关节置换术 围术期失血量 

分 类 号：R687.4[医药卫生—骨科学]