同期双侧膝关节置换和单侧膝关节置换的优劣分析

Advantage and disadvantage analysis of bilateral knee replacement simultaneous and unilateral knee replacement

目的分析同期双侧膝关节置换和单侧膝关节置换的临床效果。方法将我院2012年1月～2015年1月收治的70例膝关节置换患者随机分为观察组和对照组各35例,分别行同期双侧膝关节置换术和选择性单侧膝关节置换术。比较两组患者的手术相关指标、术前与术后1年膝关节功能及术后并发症发生情况。结果观察组患者的术后失血量为（410.3±39.6）ml,显著高于对照组患者的术后失血量[（156.2±47.5）ml]（t=24.3084,P〈0.01）;观察组患者术后3 d内的ΔHb为（40.9±11.6）g/L,显著高于对照组患者术后3 d内的ΔHb[（17.3±7.9）g/L]（t=5.7329,P〈0.01）;观察组患者的ΔHct为（12.3±2.8）%,显著高于对照组的ΔHct[（8.1±2.4）%]（t=6.7377,P〈0.01）;观察组患者术后的ROM为（117.8±3.5）°,膝关节屈曲挛缩度为（0.5±0.0）°,HSS评分为（92.5±14.7）分,均较术前[ROM（85.5±13.6）°]、膝关节屈曲挛缩度[（12.8±5.0）°]及HSS评分[（55.1±20.6）分]均明显改善（t=13.6073、10.0324、8.7431,P〈0.01）,对照组患者术后的ROM为（118.3±2.9）°,膝关节屈曲挛缩度为（2.1±0.8）°,HSS评分为（81.3±15.2）分,均较术前ROM[（86.8±14.1）°]、膝关节屈曲挛缩度[（13.1±5.9）°]及HSS评分[（58.9±23.1）分]均明显改善（t=12.9458、10.9300、4.7924,P〈0.01）,两组患者术后ROM比较,差异无统计学意义（t=0.6508,P〉0.05）;观察组患者术后膝关节屈曲挛缩度及HSS评分均显著优于对照组（t=4.5916、3.1335,P〈0.01）;观察组患者术后并发症发生率为5.71%,对照组的术后并发症发生率为11.43%,差异无统计学意义（χ2=0.1823,P〉0.05）。结论同期双侧膝关节置换术后临床效果更好,安全性相对较高,值得临床推广应用。

Objective To analyze the clinical effect of bilateral knee replacement simultaneous and unilateral knee replacement.Methods Seventy knee joint replacement patients admitted into our hospital from January 2012 to January2015 were evenly divided into observation group and control group.They were separately provided with bilateral knee replacement simultaneous and unilateral knee replacement.The surgical relevant indexes,knee joint function before surgery and one year after surgery,and occurrence of postoperative complications were compared in the two groups.Results In the observation group,the amount of postoperative bleeding was（410.3±39.6） ml,which was much higher than that in the control group of（156.2±47.5） ml（t=24.3084,P〈0.01）.The ΔHb within three days after surgery was（40.9±11.6） g/L in the observation group,which was greatly higher than that in the control group of（17.3 ±7.9） g/L（t=5.7329,P〈0.01）.The ΔHct in the observation group was（12.3±2.8） %,which was greatly higher than that in the control group of（8.1 ±2.4） %（t =6.7377,P 〈0.01）.In the observation group,postoperative ROM,knee flexion degree,and HSS score were（117.8±3.5）°,（0.5±0.0）°,（92.5±14.7） points in comparison with those before surgery of（85.5±13.6）°,（12.8±5.0）°,（55.1±20.6） points,with statistically significant differences（t=13.6073,10.0324,8.7431,P〈0.01）.In the control group,postoperative ROM,knee flexion degree,and HSS score were（118.3 ±2.9）°,（2.1 ±0.8）°,（81.3±15.2） points in comparison with those before surgery of（ 86. 8 ± 14. 1） °,（ 13. 1 ± 5. 9） °,（ 58. 9 ± 23. 1） points. After comparison, improvement after surgery was great（ t = 12.9458,10.9300,4.7924,P〈0.01）.There was no difference in postoperative ROM（t=0.6508,P〉0. 05）.The postoperative knee joint flexion degree and HSS score were both superior to those in the control group（ t = 4.5916,3.1335,P〈0.01）.The incidence of postoperative complications was 5.71% in the observation group,and the incidence was 11.43% in the control group,without a significant difference（χ2=0.1823,P 〉0.05）.Conclusion Bilateral knee replacement simultaneous can obtain a better effect in higher safety compared with unilateral one,which is worthy of clinical application and promotion.