双膝骨关节炎一期与二期全膝关节置换的比较

目的比较双侧膝关节骨关节炎行一期或二期双侧全膝关节置换术(total knee arthroplasty,TKA)的临床疗效和安全性。方法回顾分析我院2005年4月至2012年4月93例双侧膝关节骨关节炎患者分别接受一期(A组)或二期(B组)TKA治疗的临床资料。其中A组54例,男5例,女49例,年龄56~79岁,平均(65.8±6.5)岁;B组39例,男6例,女33例,年龄53~82岁,平均(66.1±7.7)岁。术前两组患者一般资料差异无统计学意义,具有可比性。比较两组患者术后住院总天数、总出血量、隐性出血量、输血量、引流量、术后血红蛋白、治疗费用及术后疗效(KSS评分、关节活动度及并发症),根据Gross方程计算总失血量及隐性失血量。结果两组患者术后引流量、输血量、总出血量、隐性出血量、住院天数及住院总费用差异均有统计学意义(P0.05);两组患者手术前后KSS评分、术前膝关节活动度(range of motion,ROM)差异均无统计学意义(P0.05),但术后KSS评分均较术前明显改善(P0.05);两组患者术后血肿发生率、深静脉血栓(deep venous thrombosis,DVT)发生率、切口愈合不良发生率及感染率差异均无统计学意义(P0.05),但是总并发症发生率差异有统计学意义(P0.05)。结论一期双侧TKA手术创伤较大,术后并发症发生率较高,有可能增加假体周围感染的风险,因此对这一术式的选择要慎重。我们建议对于年龄较轻、术前合并疾病较少及身体素质较好的双侧膝关节骨关节炎患者,充分告知相关手术风险,并经患者同意的情况下,可考虑一期双侧TKA。

Comparison of The Clinical Outcomes and Safety after One_stage Bilateral and Two_stage Bilateral Total knee Arthroplasty

Objective To compare the clinical outcomes and safety of patients with simultaneous bilateral degenerative os- teoarthritis treatment of one-stage bilateral and two-stage bilateral total knee arthroplasty. Methods Retrospective analysis of clinical data of 93 patients with simultaneous bilateral knee degenerative osteoarthritis were treated with one-stage bilateral（A group） and two-stage bilateral（ group B） TKA in our hospital from April 2005 to April 2012. The A group had 54 patients （ male 5 ; female 49 ）. The mean age was （ 65.8 ± 6.5 ） years ; The B group had 39 patients （ male 6 ; female 33 ）. The mean age was （ 66.1 ± 7.7 ） years. Two groups of patients were compared with following data, including length of hospital stay, the total a- mount of bleeding, occult bleeding, blood transfusion, drainage, postoperative hemoglobin, hospital costs, and postoperative out- comes（ the KSS score ,range of motion, and complications）. The total amount of blood loss and occult bleeding was calculated according to Gross equation. Results There were statistically significant differences in the term of postoperative drainage, blood transfusion, the total amount of bleeding, occult bleeding, length of hospital stay, and hospital costs （ P 〈 0.05 ） ; There were no statistically significant differences in the term of postoperative KSS score and ROM（ P 〉0.05 ）. But the postoperative KSS score in both groups were improved significantly compared with before KSS score （ P 〈 0.05 ） ; There were no statistically significant differences in the term of postoperative hematoma, DVT , incidence of poor wound healing , and infection rates （ P 〉 0.05 ）. But overall incidence of postoperative complications in A group was higher than B group （ P 〈 0.05 ）. Conclusion One-stage bilateral TKA had an increased surgical trauma, a higher incidence of postoperative complications, which may be lead to a high risk of periprosthetic infection. We suggest that if patients with bilateral degenera