协和医学杂志

2011, v.2(01) 56-60

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同一住院周期一期与分期双侧全膝关节置换疗效比较
Effectiveness and Safety of Simultaneous or Staggered Bilateral Total Knee Arthroplasty in One Hospitalization

王炜;翁习生;林进;金今;钱文伟;邱贵兴;
WANG Wei,WENG Xi-sheng,LIN Jin,JIN Jin,QIAN Wen-wei,QIU Gui-xing Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Science & Peking Union Medical College,Beijing 100730,China

摘要(Abstract):

目的比较同一住院周期内进行一期双侧全膝关节置换(total knee arthroplasty,TKA)和分期双侧TKA的临床差异。方法回顾性分析2003至2008年因双膝原发性骨关节炎,在本院一个住院周期内接受双膝关节表面置换手术且随访资料满2年的患者233例。根据双侧膝关节手术时间不同分为一期手术组和分期手术组,分别比较两组患者术前因素、治疗因素和疗效间的差异。术前因素包括年龄、体重指数(体重kg/身高m2)、病程时间(从起病到手术)和术前合并症;治疗因素包括术前住院时间、总住院时间、双侧手术总时间、双侧术中总止血带时间、双侧手术总引流量、总输血量;疗效判定采用术前HSS评分、术后2年时HSS评分及HSS评分改善程度(末次与术前HSS评分的差值)作为量化标准,并统计并发症的种类及例数。结果一期手术组患者191例(男性31例,女性160例),分期手术组患者42例(男性5例,女性37例)。分期手术组术前合并症率明显高于一期手术组,但两组年龄、体重指数、病程时间比较差异无统计学意义(P>0.05)。分期手术组总住院时间明显长于一期手术组(P<0.01),但一期手术组总输血量明显多于分期手术组(P<0.01),两组术前住院时间、总手术时间、总止血带时间、总引流量比较差异无统计学意义(P>0.05)。两组术前、术后2年时HSS评分比较差异无统计学意义(P>0.05)。一期手术组术后伤口并发症率高于分期手术组,两组仅有小腿肌间静脉发生血栓,且发病率比较差异无统计学意义。两组均无严重并发症发生、住院死亡率均为0。结论在合理选择患者并进行完善的术前准备下,同一住院周期内一期双膝TKA和分期双膝TKA具有相同的安全性和临床效果。
Objective To compare the clinical effectiveness and safety between simultaneous and staggered bilateral total knee arthroplasty(TKA)in one hospitalization.Methods We retrospectively analyzed 233 patients with primary osteoarthritis of both knee joints who received bilateral TKA in one hospitalization and follow-up for at least 2 years.These patients were grouped into simultaneous group and staggered group based on the procedures they received.The age,body weight index(BWI),years lived with disorder(YLD),pre-operative co-morbidity,pre-operative hospitalization time,total hospitalization time,total operation time,total toniquet time,total drainage volume,total blood transfusion volume,pre-operative Hospital for Special Surgery(HSS)score,post-operative HSS score(2 years),complications,and its ratio were reviewed and analyzed with one tail t test.Results The simultaneous group included 191 cases(31 males and 160 females)and the staggered group included 42 cases(5 males and 37 females).The pre-operative co-morbidity rate was significantly higher in the staggered group than in the simultaneous group,while no such significant difference existed in terms of age,BWI,and YLD(P>0.05).The total hospitalization time of staggered group was significantly longer than that in the simultaneous group,while the total blood transfusion volume was significantly less(both P<0.01).The pre-operative hospitalization time,total operation time,total toniquet time,and total drainage volume were not significantly different between these two groups(P>0.05).The HSS scores before operation and 2 years after operation were also not significantly different(P>0.05).The wound complication rate was higher in the simultaneous group than the staggered group.Thromboembolism events occurred only in calf muscular veins in both groups with similar incidences.No patients suffered from severe complication or died during hospital stay.Conclusion With reasonable patient selection and delicated pre-operative preparation,simultaneous bilateral TKA has similar clinical effectiveness and safety as staggered bilateral TKA.

关键词(KeyWords): 全膝关节置换,双侧;一期手术;分期手术
total knee arthroplasty,bilateral;simultaneous;staggered

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作者(Author): 王炜;翁习生;林进;金今;钱文伟;邱贵兴;
WANG Wei,WENG Xi-sheng,LIN Jin,JIN Jin,QIAN Wen-wei,QIU Gui-xing Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Science & Peking Union Medical College,Beijing 100730,China

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