双膝人工关节同期置换与选择性单膝置换近期临床效果分析

The analysis of early clinical effects of simultaneous bilateral total knee arthroplasty and selective unilateral total knee arthroplasty

目的比较双膝人工关节同期置换与选择性单膝置换的临床效果。方法本研究回顾性分析2010年6月至2011年9月,山东大学齐鲁医院收治的因骨性关节炎行人工全膝关节置换术患者154例,分为双膝置换组与单膝置换组,通过记录两组患者术前与术后3、6个月,1年的KSS评分,WOMAC指数(西安大略麦马斯特大学骨性关节炎指数可视化量表),VAS评分(疼痛视觉模拟评分),术后并发症,住院时间,住院期间费用(假体费用除外)及术后复查影像学表现分析两组患者的临床效果,并以SPSS13.0软件做统计学分析,P<0.05有统计学意义。结果双膝置换组患者51例(男8例,女43例);单膝置换组患者103例(男35例,女68例)。术前两组年龄、性别、体重指数、病程时间、VAS评分等比较差异无统计学意义(P>0.05)。双膝置换组术后3、6个月,1年的KSS评分及WOMAC指数与单膝置换组差异无统计学意义(P>0.05),两组术后膝关节功能均得以改善,VAS评分两组差异无统计学意义(P>0.05),但男性患者的痛觉阈值普遍较高。平均住院时间双膝组略长(P<0.05),住院费用(假体费用除外)双膝置换组高,(P<0.05)。术后并发症双膝置换组高于单膝组,双膝置换组5例发生下肢深静脉血栓(9.80%),肺心脑血管并发症3例(5.88%),肺栓塞2例(3.92%)。单膝组并发感染1例(0.97%)。两组均无死亡病例。结论同期双膝人工关节置换和选择性单膝置换临床效果相当,但双膝同期置换住院时间长,术后血栓发生率及心肺脑血管并发症高,术前应予足够重视。

Objective To compare the clinical effects of simultaneous bilateral total knee arthroplasty （TKA） and selective unilateral TKA. Methods A total of 154 patients with osteoarthritis had TKA from June 2010 to September 2011, whose data were retrospectively analyzed. These patients were divided into 2 groups： the bilateral TKA group and the unilateral TKA group. Based on the Knee Society Score （KSS）, Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC）, Visual Analogue Scale （VAS）, postoperative complications, hospital stays, hospitalization costs （excluding the prostheses costs） and the postoperative imaging finds in both groups preoperatively and 3, 6 and 12 months after the surgery, the clinical effects was analyzed. The statistical analysis was done by using the Statistical Package for the Social Science （SPSS） 13.0 software, and P〈0.05 meant that there were statistically significant significances. Results There were 51 patients in the bilateral TKA group, （including 8 males and 43 females）, and 103 patients in the unilateral TKA group, （including 35 males and 68 females）. Preoperatively there were no statistically significant significances between the 2 groups in the age, gender, body mass index, course time, VAS and so on （P〉0.05）. There were no statistically significant significances in the KSS and WOMAC between the bilateral TKA group and the unilateral TKA group 3, 6 and 12 months postoperatively （P〉0.05）. The knee function got improved in both groups postoperatively, and the differences in the VAS were not statistically significant （P〉0.05）. However, the threshold value of pain perception was commonly higher in male patients. The mean hospital stay was a little longer in the bilateral TKA group （P〈0.05）, and the hospitalization costs （excluding the prostheses costs） were also higher （P〈0.05）. The postoperative complications were more in the bilateral TKA group, when compared with those in the unilateral TKA group. 5 cases of lower limb deep venous thrombosis （DVT） （9.80%）, 3 cases of cardiovascular and cerebrovascular diseases （5.88%） and 2 cases of pulmonary embolism （3.92%） occurred postoperatively in the bilateral TKA group. 1 case of joint infection was noted in the unilateral TKA group （0.97%）. There were no death cases in both groups. Conclusions The simultaneous bilateral TKA is not superior to the selective unilateral TKA in the clinical efficiency, with longer hospital stay and more complications such as pulmonary embolism and cardiovascular and cerebrovascular diseases. So when the simultaneous bilateral TKA is performed, enough attention should be paid preoperatively.