同时双侧全膝表面置换与单侧全膝关节置换围手术期康复的比较

背景：目前对于双膝严重骨性关节炎行两组同时双侧全膝表面置换的围手术期康复的相关研究尚不多见。目的：比较双膝骨性关节炎两组同时双侧全膝表面置换术与单侧全膝关节置换围手术期康复训练的效果。方法：两组医生对59例（118膝）患者双膝骨性关节炎同台同时全膝表面置换,与同期80例单膝骨性关节炎行单侧全膝关节置换患者（对照组）进行疗效比较。两组患者置换前均进行康复教育及预备康复,置换后康复方法标准一致。结果与结论：同时双侧全膝表面置换组置换前通过压腿平均减小屈曲畸形角度11.2°（5°～22°）。置换后3～6周,股四头肌、腘绳肌肌力5级,较置换前平均增加0.8级;平均ROM≥95°（110±15）°;无痛行走500m以上;独自无痛上下10级楼梯,无肿胀;出院时HSS评分较置换前增加。置换后3个月没有发现松动表现及不良反应,其康复疗效与对照组对比差异无显著性意义。表明,在围手术期对双膝骨性关节炎两组医生行同时双侧全膝表面置换,通过系统而量化的康复,有利于减少置换中截骨量和置换后并发症,促进患者膝关节功能恢复,与单侧全膝关节置换相比康复结果无明显差异。

Peri-operative rehabilitation of simultaneous bilateral total knee arthroplasty versus unilateral total knee arthroplasty

BACKGROUND：There are few reports concerning the peri-operative rehabilitation of two-team simultaneous bilateral total knee arthroplasty（SBTKA） in patients with bilateral end-stage degenerative osteoarthritis（OA） of the knee.OBJECTIVE：To compare the peri-operative rehabilitation outcomes of OA patients undergoing SBTKA and unilateral TKA（UTKA）.METHODS：The experiment group composed of 59 OA patients（118 knees） undergoing SBTKA had been given same rehabilitation as the control group that had 80 OA patients undergoing UTKA.The results were compared.RESULTS AND CONCLUSION：In the experiment group,preoperative flexion deformity angle was decreased 5°-22°（averagely 11.2°）;postoperatively,the average muscle strength increased 0.8 degree to 5;Average range of motion was ≥95°（110°±15°）.Patients were able to walk more than 500 m and go up and down more than 10 stairs without pain or swelling.Upon discharge,average HSS score increased.There was no obvious difference in rehabilitation outcome between the two groups at 3 months after operation.Perioperative rehabilitation with SBTKA can reduce bone loss and postoperative complications,improve patients functional recovery,but there is no difference in peri-operative rehabilitation outcome between OA patients undergoing SBTKA or UTKA.