同期和分期全膝关节置换术治疗老年双膝关节骨关节炎的治疗效果

Clinical study of simultaneous bilateral versus staged bilateral total knee arthroplasty in treatment of osteoarthritis in elderly patients

目的研究老年双膝骨性关节炎患者选择同期和分期全膝关节置换术的治疗效果。方法选择我院2013年1月至2014年6月接受双膝关节置换术的患者49例。其中同期置换治疗患者为28例,分期置换治疗患者为21例,回顾性分析2组患者的治疗情况,比较2种手术方案的临床效果。结果同期全膝关节置换术在手术时间、住院时间方面具有优势,而分期关节置换术在术后血红蛋白、术后引流量和术后输血量方面具有优势,差异具有统计学意义(P<0.05或P<0.01);在并发症方面,同期全膝关节置换术后发热和并发症发生率明显高于分期治疗患者,差异具有统计学意义(P<0.05);在膝关节功能评分(HSS评分)和膝关节活动度方面,2组差异无统计学意义(P>0.05)。结论同期和分期双侧全膝关节置换术治疗双侧膝骨关节炎均能够取得理想的术后功能恢复,掌握好手术指征以确保取得最佳的治疗效果。

Objective To compare the clinical effect of simultaneous bilateral total knee arthroplasty with staged bilateral total knee arthroplasty in treatment of bilateral knee osteoarthritis in elderly patients. Methods A total of 49 patients with both knee osteoarthritis were retrospectively analyzed,who underwent total knee arthroplasty from January 2013 to June 2014. This study included 28 cases of simultaneous bilateral total knee arthroplasty and 21 cases of staged bilateral total knee arthroplasty. The clinical effect of two groups were retrospectively analyzed. Results Operation time and hospitalization time of the simultaneous bilateral total knee arthroplasty group were obviously lower than those of the staged bilateral total knee arthroplasty group. In addition,staged bilateral total knee arthroplasty showed advantage in postoperative hemoglobin,postoperative drainage and blood transfusion,compared with simultaneous bilateral total knee arthroplasty（ P0. 05 or P0. 01）. The incidence rate of postoperative fever and the number of complications was higher in simultaneous bilateral total knee arthroplasty group（ P0. 05）. There was no significant difference between the two groups in HSS score and knee joint activity（ P 0. 05）. Conclusions Simultaneous bilateral and staged bilateral total knee arthroplastyin could acquire satisfied effect. The mastery of operative indications is of great significance to the excellent clinical effect.