全膝关节初次单侧表面置换与双侧同时置换术后并发症的比较分析

Postoperative complications following primary unilateral and simultaneous bilateral total knee arthroplasty

目的 比较全膝关节初次单侧表面置换与双侧同时置换术后并发症的发生情况。方法对2006年11月至2009年11月收治且获得随访的339例初次行全膝关节表面置换患者的资料进行回顾性分析，根据是否行双膝关节表面置换分为两组：单膝置换组（行单侧膝关节表面置换）178例，男50例，女128例；平均年龄64．2岁（26～81岁）；术前美国膝关节协会（KSS）评分平均为（34．0±13．3）分。双膝置换组（行双侧膝关节表面置换）161例，男32例，女129例；平均年龄65．3岁（34～80岁）；术前KSS评分平均为（33．4±11．1）分。比较两组患者术后并发症的发生情况，并采用KSS评分评定临床疗效。结果 339例患者术后获3个月至3年（平均18．4个月）随访。单膝置换组术后并发症发生率为6．2％（11／178），双膝置换组术后并发症发生率为4．3％（7／161），两组比较差异无统计学意义（x^2=0．564，P=0．453）。末次随访时单膝置换组KSS评分平均为（92．5±10．6）分，双膝置换组平均为（91．9±11．1）分，两组比较差异无统计学意义（t=0．511，P=0．610）。结论 双膝关节置换与单膝关节置换术后并发症发生率无明显差异。术前充分准备、较好的手术技术、完善的术后监测和支持治疗及合理的康复训练，可以降低一期双膝关节置换术后并发症的发生率；但对于术前合并多种内科疾病的患者，应认真评估手术耐受性后再进行抉择。

Objective To compare postoperative complications in patients firstly undergoing primary unilateral total knee arthroplasty （UTAK） and simultaneous bilateral total knee arthroplasty （SBTKA） . Methods From November 2006 to November 2009, 339 patients underwent primary UTAK and SBTKA in our hospital and followed up. The UTKA group had 178 patients （50 men and 128 women） who were aged from 26 to 81 years （mean, 64.2 years） and a mean American Knee Society Score （KSS） of 34. 0±13.3 points before surgery. The SBTKA group had 161 patients （32 men and 129 women） who were aged from 34 to 80 years （mean, 65.3 years） and a mean KSS of 33.4 ± 11.1 points before surgery. The postoperative complications were compared between the 2 groups and clinical outcomes were evaluated according to KSS system. Results The patients were followed for 18.4 months on average（range, 3 months to 3 years） . The incidence of postoperative complications was 6.2% （11/178） in the UTKA group and 4.3% （7/161） in the SBTKA group, with no significant difference （X^2 =0. 564, P =0. 453） . The KSS score at the final fol- low-up was all increased in both groups. It was 92.5 ±10.6 in the UTKA group and 91.9±11. 1 in the SBTKA group, with no significant difference （ t = 0. 511, P = 0. 610）. Conclusions SBTKA is not an independent risk factor for postoperative complications. Careful operative preparation and assessment, good surgical skills, comprehensive postoperative monitoring and supporting management, and proper rehabilitation can significantly reduce complications following SBTKA. But for a patient who has been complicated with multiple internal diseases, SBTKA decision should not be made before a careful tolerance assessment of the patient.