同期双侧全膝关节置换与选择性单侧全膝关节置换后的早期功能恢复

背景：同期双侧全膝关节置换与选择性单侧全膝关节置换后的早期功能恢复一直存在着争议。目的：评价双膝骨关节炎患者同期双侧全膝关节置换与选择性单侧全膝关节置换后功能恢复情况的差异。方法：根据置换方案将初次行全膝关节置换的双膝骨关节炎患者86例(116膝)分为两组，双膝组(n=29，58膝)行同期双侧全膝关节置换，单膝组(n =57，57膝)行单侧全膝关节置换。分别对两组患者置换前后的关节活动度、屈曲挛缩度、肌力、疼痛评分、双下肢不等长及HSS评分进行比较分析，并记录并发症的发生率。结果与结论：置换后1年随访，两组患者置换后关节活动度和肌力差异无显著性意义(P=0.171，0.418)；置换后屈曲挛缩度、疼痛评分及双下肢不等长双膝组均显著低于单膝组(P=0.006，0.0013，0.026)；同时双膝组置换后HSS评分优于单膝组(P=0.003)。提示同期双侧全膝关节置换患者在屈曲挛缩度、疼痛症状评分、双下肢不等长及HSS评分方面优于单侧全膝关节置换，而两种方案在置换后关节活动度和下肢肌力方面无明显差异。

Early functional recovery following bilateral total knee replacement versus selective unilateral total knee replacement

BACKGROUND: Early functional recovery following bilateral total knee replacement or selective unilateral after total knee arthroplasty are still controversial.OBJECTIVE: To evaluate the function recovery differences of patients with osteoarthritis knees after bilateral total knee replacement or selective unilateral total knee replacement. METHODS: 86 cases with osteoarthritis (116 knees) performed first line total knee replacement were divided into the bilateral total knee replacement group (n=29, 58 knees), and unilateral total knee replacement group (n=57, 57 knees). Preoperative and postoperative range of motion (ROM), flexion contracture, muscle strength, pain score, leg-length discrepancy and HSS ratings were compared, and the incidence of complications were recorded. RESULTS AND CONCLUSION: There were no significances between two groups in ROM and muscle strength at 1 year follow-up (P=0.171, 0.418); Postoperative flexion contracture, pain score, and leg-length discrepancy of the bilateral total knee replacement group were obviously lower than those of the unilateral total knee replacement group (P=0.026, 0.0013, 0.026); meanwhile, the postoperative HSS score of the bilateral total knee replacement group was superior to the unilateral total knee replacement group (P=0.003). It is suggested that bilateral total knee replacement is superior to the unilateral total knee replacement in flexion contracture, pain score, leg-length discrepancy and HSS ratings, but there is no obviously difference in ROM and muscle strength.