同期双侧膝关节置换术治疗严重畸形膝关节病18例

Simultaneous bilateral total knee arthroplasty in the treatment of 18 patients with severely deformed knee joint disease

目的探讨同期双膝关节置换术在严重畸形膝关节病患者中的应用效果。方法将36例严重畸形膝关节病患者随机分为观察组(n=18)与对照组(n=18),观察组给予同期双侧膝关节置换术治疗,对照组给予分期双侧膝关节置换术治疗,比较2组患者的治疗效果。结果观察组手术时间及总住院天数均显著短于对照组(P<0.01),术后引流量及术中输血量2组比较无显著差异(P>0.05);随访1年后,2组ROM、下肢肌力比较无显著差异(P>0.05);观察组膝关节挛缩屈曲度、疼痛评分及双下肢长度差异显著小于对照组(P<0.05或P<0.01),HSS评分显著高于对照组(P<0.05);2组并发症发生率比较无显著差异(P>0.05)。结论同期双侧膝关节置换术能够有效缩短严重畸形的膝关节病患者总体手术时间及住院时间,减轻患者痛苦,降低术后关节挛缩及下肢缩短等畸形的发生。

Objective To discuss the clinical effects of simultaneous bilateral total knee arthroplasty （TKA） in patients with severely deformed knee joint disease. Methods Thirty-six pa- tients with severely deformed knee joint disease were randomly divided into observation group （ n = 18） and control group （n = 18）. The observation group was treated with simultaneous bilateral TKA, while the control group was treated with staged bilateral TKA, and then the clinical effects were compared between the two groups. Results The operation time and total hospitalization time of the observation group were significantly shorter than the control group （P 〈 0.01）, but postoper- ative drainage and intraoperative blood transfusion were not significantly different （P 〉 0.05 ）. There were no significant differences between two groups in ROM and muscle strength after 1-year follow-up（P 〉0.05）. Flexion contracture, pain score, and leg-length discrepancy of the observa- tion group were significantly lower than those of the control group（P 〈 0.05 or P 〈 0.01 ）. HSS of the observation group was significantly higher than that of the control group（ P 〈 0.05）. There was no significant difference in the incidence of complications（P 〉0.05）. Conclusion Simultaneous bi- lateral TKA has confirmed effects in patients with severely deformed knee joint disease, but we should consider the general condition of the patients and select the appropriate procedure to ensure patients＇ safety.