双侧全髋关节同期与分期置换近期临床疗效分析及安全性比较

Comparison of short-term clinical outcomes and safety of simultaneous vs staged bilateral total hip arthroplasty

目的比较终末期髋关节疾患同期与分期行THA的安全性及近期临床疗效。方法回顾性分析自2006-01—2014-12诊治的行双侧THA的髋关节疾患68例（136髋）,其中同期行双侧THA 26例（同期组）,分期行双侧THA 42例（分期组）。比较2组手术时间、失血量、输血量、住院时间及治疗费用、术后双侧肢长差异、术前术后功能评分、围术期并发症等。结果 68例术后均获随访平均1.6（1~3）年。2组的手术时间（t=2.01,P=0.751）、总失血量（t=1.473,P=0.651）、总输血量（t=0.87,P=1.051）、术后Harris功能评分（t=0.23,P=2.053）差异无统计学意义。而住院时间（t=-9.73,P=0.041）、住院费用（t=-2.35,P=0.035）、术后肢长差异（t=-4.76,P=0.025）差异有统计学意义。2组随访时间内均未出现切口感染、人工关节脱位、假体松动等并发症,2例术后出现深静脉血栓（同期组和分期组各1例）,6例出现术后谵妄症状（同期组2例,分期组4例）。结论在患者全身情况良好、围术期管理得当、医生手术技术熟练的情况下,同期行双侧THA是安全可行的,且在患者总住院时间、总住院费用、术后肢长差异方面与分期行双侧THA相比有一定的优势。

Objective To compare short-term clinical efficacy and safety of simultaneous vs staged bilateral total hip arthroplasty for end-stage hip diseases. Methods Sixty-eight cases（136 hips） undergoing bilateral THA from January 2006 to December 2014 were reviewed retrospectively. Synchronous bilateral THA was performed in 26 cases（synchronous group）and staged bilateral THA in 42 cases（staged group）. Two groups were compared in total operation time, total amount of blood loss, total amount of blood transfusion, duration and cost of hospitalization, postoperative discrepancy in bilateral leg length,preoperative and postoperative function score and perioperative complications. Results Follow-up period was 1-3 years（average of 1.6 years）. There were no statistical differences between synchronous group and staged group in total operating time（t =2.01, P =0.751）, total amount of blood loss（t =1.473, P =0.651）, total amount of blood transfusion（t =0.87, P =1.051）,postoperative function score（t =0.23, P =2.053）. However, differences of the following data were considered statistical significance between synchronous group and staged group： length of hospitalization（t =-9.73, P =0.041）, expense of hospitalization（t =-2.35, P =0.035）, postoperative discrepancy in bilateral leg length（t =-4.76, P =0.025）. During the followup no complications of incision infection, prosthesis dislocation and loosening were noted. Two patients had postoperative deep vein thrombosis（each in synchronous group and staged group）. And postoperative delirium symptoms occurred in six cases（two in synchronous group and four in staged group）. Conclusion Simultaneous bilateral THA is safe and feasible as far as the patients＇ physical condition are allowed, perioperative management is rational and physicians have mature surgical techniques.Moreover, it gains advantage over staged bilateral THA considering cost of hospitalization, length of hospitalization and postoperative discrepancy in bilateral leg.