Ⅰ期双侧全膝置换术的风险及疗效

Risk and curative effect of bilateral total knee arthroplasty in one-stage procedure

目的 探讨Ⅰ期双侧全膝置换术 (bilateraltotalkneearthroplasty,BTKA)的手术风险及疗效。 方法 对 71例Ⅰ期双侧全膝置换术的并发症进行统计分析 ,并采用Hospitalforspecialsurgery (HSS)评分随访疗效。 结果 术中出现股骨髁上骨折 1例 ,失血性休克 4例 ;术后出现脑栓塞 2例 ,精神萎靡或错乱 7例 ,失血性休克 2例 ,心律失常 2例 ,肺部感染 3例 ,静脉血栓形成 11例 ,泌尿系感染 5例 ,应激性溃疡 1例。无肺栓塞及死亡病例。经过术后 3个月～ 9年 (平均 49.4个月 )的随访 ,回访 49例未见假体松动移位或晚期感染病例 ,术后HSS评分平均 87.7分 ( 71～ 94分 )。结论 Ⅰ期双侧全膝置换患者可获得好的疗效 ,但容易出现术中、术后并发症 ,特别对于年龄>70岁或术前合并心肺疾病的患者。Ⅰ期双侧全膝置换术应在确保安全的前提下实施。术前评估 ,术中、术后监测 ,足量输血和具备丰富经验的手术、麻醉医师 。

Objective To determine risk and curative effect of bilateral total knee arthroplasty (BTKA) in one-stage procedure. Methods The complications of 71 patients operated with BTKA in one-stage procedure were statistically analyzed. They were followed up and the curative effect determined with hospital for special surgery (HSS) score. Results There appeared 1 case with femoral condylar fracture and 4 with hemorrhagic shock during operation. After operation, there were 2 cases of cerebral embolism, 7 psychological fusion, 2 hemorrhagic shock, 2 arrhythmia, 3 pulmonary infection, 11 vascular embolization, 5 genitourinary infection and 1 gastrointestinal ulcer. No pulmonary embolism or death occurred. However, there was a higher incidence of cardiac and neuropsychological complications in patients over 70 years old and in those who attended by a bad pre-existing systemic condition. The follow up for average 49.4 months (3 months-9 years) in 49 cases showed no osteolysis or terminal infection with a mean postoperative HHS score of 87.7 (71-94 scores). Conclusions Patients can gain a better capability of walking after their BTKA in one-stage procedure. But there is an increased risk of complications during and after operation. Especially, the risk of complications is even more significant in patients with a bad pre-existing systemic condition or those over 70 years old. Therefore, BTKA in one-stage procedure must be done under secure conditions. Preoperative evaluation, intraoperative and postoperative monitorings, sufficient transfusion and experienced anesthesiologists and orthopaedic total knee replacement surgeons are necessary for employment of BTKA in one-stage procedure.