一期双膝关节与单膝关节置换术围手术期并发症比较

Comparison of perioperative com plications between primary bilateral and unilateral total knee arthroplasty

目的比较一期双膝关节与单膝关节置换术的围手术期并发症。方法1996年10月至2006年10月，行初次全膝关节置换术的患者497例，男112例，女385例；年龄24-86岁，平均66岁；行一期双膝关节置换术171例，单膝关节置换术326例。比较两组患者的术前合并症、围手术期并发症等。结果两组患者平均年龄、性别比例及术前合并症比较，差异均无统计学意义。一期双膝关节置换术后平均出血量为1050．90ml（963．36-1138．44ml），输血量为400-2800ml；单膝关节置换术后平均出血量为466．75ml（444．85-488．65ml），输血量为0-1200ml。一期双膝关节置换术与单膝关节置换术后出血量及输血量比较，差异有统计学意义。围手术期深静脉血栓形成和肺栓塞的发生率、消化系统并发症的发生率、浅表伤口愈合不良的发生率及术后2年深部感染的发生率比较，差异无统计学意义。一期双膝关节置换术与单膝关节置换术相比，术后心血管系统并发症（P=0．0003）及神经系统并发症（P=0．0356）的发生率增高。结论术前对患者进行全面的健康评估，积极治疗术前合并症，对降低一期双膝关节置换术的风险至关重要。当患者术前存在心脑血管合并症时，应避免采用一期双膝关节置换术。对于存在高风险的患者，术前应向其充分交待手术风险及术中有临时决定改为分期手术的可能。

Objective To compare the rates of pefioperative complications in consecutive patients undergoing primary bilateral total knee arthroplasty or unilateral total knee arthroplasty. Methods 497 patients underwent total knee arthroplasty between October 1996 and October 2006, which included 112 males and 385 females, with the mean age of 66 years （ranged from 24 to 86 years）. The operations consisted of 171 primary bilateral and 326 unilateral total knee arthroplasty. The rates of perioperative complications were compared. Results The blood loss and the amount of transfusion were significantly higher in the primary bilateral group. No significant differences were found with regard to deep venous thrombosis, pulmonary embolism, gastrointestinal complications, superficial wound complications and infection rate in two years. The rates of cardiovascular complications （P=0.0003） and cerebrovascular complications （P=0.0356） was significantly higher in the primary bilateral group than in the unilateral group. Conclusion Preoperative health condition should be assessed carefully. Patients with pre-existing cardiovascular or cerebrovascular diseases are at significant risk with primary bilateral total knee arthroplasty. Therefore, this procedure should be avoided in this kind of patients, and patients must be informed of the risks and possibility of intra-operative change into unilateral total knee arthroplasty before surgery.