同期双侧与单侧全膝关节置换治疗膝骨关节炎的比较

Comparison of simultaneous bilateral versus unilateral total knee arthroplasty in treatment of osteoarthritis

[目的]比较同期双侧与单侧全膝关节置换术的安全性及临床疗效。[方法]回顾性分析2000年5月～2009年5月,因骨关节炎行硬膜外麻醉下初次全膝关节置换术患者705例,按同期双侧置换(268例)和单侧置换(437例)分为两组,比较两组患者的围手术期并发症、术后失血量、输血量、住院时间、费用与KSS临床及功能评分等各项指标。[结果]存在围手术期并发症的患者比例,双侧组(15.6%)高于单侧组(7.8%),其中心血管系统并发症发生率双侧组(7.3%)高于单侧组(3.2%)。感染、死亡、肺栓塞等围手术期并发症发生率,两组之间差异无统计学意义。术后失血量及输血量双侧组高于单侧组。术后2年KSS临床评分两组间差异无统计学意义,KSS功能评分,双侧组高于单侧组,差异有统计学意义。[结论]对于双侧膝骨关节炎的患者,在硬膜外麻醉下行同期双侧全膝关节置换术经济、高效,且有理想的手术疗效。术前应对患者做全面健康评估,对存在严重合并症,尤其是心血管系统疾病患者,应尽量避免行同期双侧全膝关节置换术。

[Objective]To evaluate the safety and clinical efficacy of simultaneous bilateral total knee arthroplasty versus unilateral total knee arthroplasty under epidural anesthesia in treatment of osteoarthritis.[Methods]Totally 705 patients underwent total knee arthroplasty between May 2000 and May 2009,which included 268 simultaneous bilateral total knee arthroplasties and 437 unilateral total knee arthroplasties.The perioperative complications,hematologic indicators,cost of hospitalization and clinical outcome indicators were compared.[Results]The post-operative complication ineidence was significantly higher in the simultaneous bilateral group（15.6%）when compared with the unilateral group（7.8%）.The rate of cardiovascular complications was significantly higher in simultaneous bilateral group（7.3%）than in the unilateral group（3.2%）.There was no increase in the rate of other post-operative complications such as infection,mortality,pulmonary embolism in simultaneous bilateral group.The simultaneous bilateral procedures had a significantly higher postoperative blood loss and blood transfusion.No significantly differences were found with regard to post-operative Knee Society scores（KSS）at 2-year follow-up.Knee Society function scores were higher in the simultaneous bilateral group.[Conclusion]It was concluded that simultaneous bilateral total knee arthroplasty under epidural anesthesia may be considered to be lower overall hospital cost and sooner recovery.Preoperative health condition should be assessed carefully.Patients at high risk,especially those with severe cardiovascular disease should avoid simultaneous bilateral total knee arthroplasty.