同一住院周期同时与分次双侧全膝关节置换的对比研究

Comparative Study of One-stage versus Two-stage Bilateral Total Knee Arthroplasty in the Same Period of Hospitalization

目的:探讨同一住院周期内进行同时双侧全膝关节置换(TKA)和分次双侧TKA的临床差异。方法:回顾性分析2015年3月至2016年3月因原发性双膝骨性关节炎在本院一个住院周期内行双侧TKA且随访6个月以上的128例患者的临床资料,根据手术的时间不同分为一期分次双侧TKA组和一期同时双侧TKA组。比较两组患者术前基本情况(年龄、体质量指数(BMI)、术前合并症和假体种类);围手术期情况(手术风险评分(NNIS)、总失血量、输血量、总手术时间、住院时间)及术后疗效(美国特种外科医院(HSS)膝关节评分、视觉模拟评分(VAS)、术后并发症发生情况。结果:两组患者性别构成、BMI的差异无统计学意义(P>0.05),但一期分次双侧TKA组年龄较大、术前合并症较多;术后两组患者VAS评分、HSS评分的差异均无统计学意义;一期同时双侧TKA组虽然住院时间短,但NNIS评分、总失血量、输血量及术后并发症发生率明显高于一期分次双侧TKA组,差异有统计学意义(P<0.05)。结论:对于年龄较大、术前合并症较多的双膝骨性关节炎患者,一期分次双侧TKA仍是不错的选择。

Objective：To explore the clinical effect of one-stage versus two-stage bilateral total knee arthroplasty in the same period of hospitalization.Methods：Followed up for more than 6 months,the clinical data of 128 patients with primary knee osteoarthritis were retrospectively analyzed,who were performed bilateral TKA in our hospital from March 2015 to March 2016 in one period of hospitalization.The patients were divided into one-stage bilateral TKA group and two-stage bilateral TKA group according to the operation time.The basic situation of the two groups（age,body mass index,preoperative complications and prosthesis type）,perioperative conditions（NNIS,total blood loss,blood transfusion,total operative time and hospitalization time）and postoperative outcomes（HSS knee score,VAS,postoperative complications）were compared between the two groups.Results：There was no significant difference between the two groups in gender composition,BMI,but the patients in two-stage bilateral TKA group were older and had more preoperative complications.There was no significant difference in VAS score and HSS score between the two groups after operation.Although the hospitalization time was shorter in one-stage group,but the NNIS score,total blood loss,blood transfusion and postoperative complications were significantly higher than that of two-stage group.Conclusion：For the patients with knee osteoarthritis,who is older and with more complications,two-stage bilateral TKA in the same period of hospitalization is a good choice