重度痛风性关节炎同期或分期行双侧膝关节置换安全性与成效性比较

SAFETY AND EFFICACY OF SIMULTANEOUS VERSUS STAGED BILATERAL TOTAL KNEE ARTHROPLASTY IN PATIENTS WITH SEVERE GOUTY ARTHRITIS

目的比较重度痛风性关节炎病人同期与分期行双侧全膝关节置换术(TKA)的安全性与成效性。方法回顾性分析我院2010年1月—2019年1月收治的双侧膝重度痛风性关节炎病人36例,其中同期行双侧TKA手术18例,分期行双侧TKA手术18例。比较两组病人的输血率、平均输血量、手术后美国特种外科医院(HSS)膝关节功能评分及疼痛视觉模拟量表(VAS)评分、住院费用、术后并发症等。结果所有病人均获随访,随访时间5~14个月,平均(8.5±2.6)个月。两组间比较,术后1 d的VAS评分差异具有统计学意义(F=9.308,P<0.05),术后2、3 d的VAS评分差异无统计学意义(P>0.05),术后1、3个月的HSS评分差异无统计学意义(P>0.05)。同期组输血率及平均输血量较分期组更高,差异具有统计学意义(χ^(2)=8.00,t=10.23,P<0.05)。两组均无感染及死亡病例,两组并发症发生率差异无统计学意义(P>0.05)。同期组住院费用相对于分期组更低,差异有统计学意义(t=-44.545,P<0.05)。结论对于重度痛风性关节炎病人,同期与分期行双侧膝关节置换在术后功能恢复方面无明显差异,在经济性与成效性上同期置换优于分期置换。但是对于同期行双侧膝关节置换病人,术前应系统评估病人的耐受能力及手术安全性。

Objective To investigate the safety and efficacy of simultaneous versus staged bilateral total knee arthroplasty(TKA)in patients with severe gouty arthritis.Methods A retrospective analysis was performed for 36 patients with severe gouty arthritis of both knees who were admitted to our hospital from January 2010 to January 2019,among whom 18 underwent simultaneous bilateral TKA and 18 underwent staged bilateral TKA.The two groups were compared in terms of blood transfusion rate,mean blood transfusion volume,postoperative Hospital for Special Surgery(HSS)knee joint score and pain Visual Analogue Scale(VAS)score,hospital costs,and postoperative complications.Results All patients were followed up for 5-14 months,with a mean follow-up time of(8.5±2.6)months.There was a significant difference in VAS score at 1 day after surgery between the two groups(F=9.308,P<0.05),while there were no significant differences between the two groups in VAS score at 2 and 3 days after surgery(P>0.05)and HSS score at 1 and 3 months after surgery(P>0.05).The simultaneous group had significantly higher blood transfusion rate and mean blood transfusion volume than the staged group(χ^(2)=8.00,t=10.23,P<0.05).No infection or death was observed in either group,and there was no significant difference in the incidence rate of complications between the two groups(P>0.05).The simultaneous group had significantly lower hospital costs than the staged group(t=-44.545,P<0.05).Conclusion For patients with severe gouty arthritis,there is no significant difference in postoperative functional recovery between simultaneous bilateral TKA and staged bilateral TKA,while simultaneous bilateral TKA has better cost-effectiveness and efficacy than staged bilateral TKA.However,for patients who plan to undergo simultaneous bilateral TKA,the patient’s tolerance and surgical safety should be systematically evaluated before surgery.