一期与分期修复双侧膝关节骨关节炎的临床效果比较（英文）

Outcomes of one-stage versus two-stage total knee arthroplasty for bilateral knee arthritis

背景:当患者双侧膝关节发生退变性骨性关节炎时,是一期双侧同时全膝关节置换还是分期置换,目前仍存在争论。目的:比较一期与分期全膝关节置换修复双侧膝关节骨性关节炎的效果。方法:收集于2005年1月至2008年12月在在苏州大学附属第一医院进行治疗的双侧膝关节骨性关节炎患者,按照患者手术方法分为一期组(n=68)和分期组(n=71),采用Gemini MK II全膝关节系统分别进行一期全膝关节置换和分期全膝关节置换治疗。结果与结论:与分期组相比,一期组患者手术时间、住院时间较短,平均术后输血量较大,医疗费用较低,但两组患者的术后膝关节功能、并发症、患者满意度情况差异无显著性意义,且至末次随访均未发现假体周围骨溶解。提示尽管一期双侧全膝关节置换增加患者的输血量,但是能够节约医疗费用、减少住院天数,因此是一种安全有效的治疗双侧膝关节骨关节炎的方法,值得推广应用。

BACKGROUND：When patient presents bilateral degenerative knee osteoarthritis, one-stage or two-stage total knee arthroplasty （TKA） remains controversial at present. OBJECTIVE：To compare the outcomes of one-stage and two-stage bilateral TKA for bilateral knee arthritis. METHODS：Patients with bilateral knee arthritis were treated in the First Affiliated Hospital of Soochow University in China from January 2005 to December 2008. They were assigned to one-stage group （n=68） and two-stage group （n=71）. These patients were subjected to one-stage and two-stage bilateral TKA using Gemini MK II total knee system. RESULTS AND CONCLUSION：Compared to two-stage group, operation time and length of hospital stage were shorter, mean blood transfusion was larger, and hospital charges were lower in the one-stage group. However, no significant differences in postoperative knee function, complications, and patients’ satisfaction were detected between the one-stage and two-stage groups. No osteolysis was observed surrounding the prosthesis during final fol ow-up. These data confirmed that one-stage bilateral TKA increased the amount of blood transfusion, but could save hospital charges, and reduce the length of hospital stay. Thus, one-stage TKA is a safe effective method to treat bilateral knee arthritis, and deserves application.