不同手术方案行双侧膝关节置换术的疗效对比

Efficacy of different surgical methods for bilateral total knee arthroplasties

目的比较一期手术、一次住院分期手术与分次住院行双侧膝关节置换(TKA)的疗效并分析其影响因素。方法收集并整理分析2010年1月至2013年1月,在新疆维吾尔自治区人民医院骨科中心接受双膝关节置换的患者共217例,其中183例获得为期1年的随访。根据双侧膝关节手术间隔时间不同分为一期手术组63例(A组);分次手术组58例(B组);与分次住院组52例(C组),比较三组患者术前一般因素、术后疗效、术后并发症发生率的差异。结果 B组与C组术前合并症明显高于A组,差异有统计学意义(P<0.05),B组与C组间无统计学差异(P>0.05);A组总住院时间较B组与C组短,且差异有统计学意义(P<0.05),后二者组间无统计学差异(P>0.05);A组围术期输血量较B组和C组均高,且差异有统计学意义(P<0.05),B组与C组间无统计学差异(P>0.05);三组手术前后的HSS评分差值、总手术时间、围术期总出血量、术后并发症的发生率及死亡率的差异均无统计学意义(P>0.05)。结论在充分的术前准备和患者自身条件允许的情况下,同期或分期行双侧膝关节置换可获得相似的近期疗效。

Objective To compare the clinical outcomes of bilateral total knee arthroplasties（ TKA） of one-stage surgery,multiple staged surgeries and multiple hospitalizations,and to analyse the influence factors. Methods From January 2010 to January 2013,217 specimens were obtained from patients who underwent simultaneous and staged bilateral TKA in the Xinjiang uygur autonomous region people＇s hospital. Among the 217 patients,183 patients were followed up for at least one year. All the patients were divided into three groups： the one-stage surgery group（ group A,63 patients）,the multiplestage surgery group（ group B,58 patients）, and the multiple-hospitalization group（ group C,62patients）. A retrospective review was conducted to compare the preoperative factors,the therapeutic efficacy and the incidence of postoperative complications. Results The incidences of preoperative comorbidity in group B and group C were significantly higher than group A（ P〈0. 05）,but between group B and group C,the incidences of pre-operative comorbidity were not significantly different（ P〉0. 05）.The total hospitalization time of group A was significantly shorter than group B and group C（ P〈0. 05）,while the difference between group B and group C was not significant（ P〉0. 05）. The total blood transfusion volumes of group B and group C were significantly less than group A（ P〈0. 05）,while the difference between group B and group C was not significant（ P〉0. 05）. As for the differences in HSS scores before the operation and two years after the operation,the total amount of perioperative blood loss,the total operation time,and the postoperative complications and mortality,no significant difference was observed among the three groups（ P〉0. 05）. Conclusion Bilateral TKA of one-stage surgery,or multiple-stage surgery provides similar clinical safety and therapeutic efficacy under the condition of sufficient preoperative preparation and reasonable patient selection.