同期和分期双侧全膝关节置换的早期疗效和安全性比较

Comparison of early efficacy and safety of simultaneous and staged bilateral total knee arthroplasty

背景:原发性膝关节骨关节炎患者双侧膝关节都需要手术治疗时,选择同期还是分期双侧全膝关节置换仍然是骨科实践中的争论问题。目的:通过比较同期双侧全膝关节置换和分期双侧全膝关节置换在围术期结局和早期功能改善的差异,评价双膝关节两种不同手术方案的安全性及有效性,以期为临床决策提供参考。方法:回顾性分析2016年1月至2021年1月于大连大学附属中山医院骨科接受双侧全膝关节置换治疗膝骨关节炎的患者资料,分为同期组(n=82)和分期组(n=75)。比较两组患者术前一般资料、住院时间、住院费用、手术时长、输血量、疼痛目测类比评分、围术期内血红蛋白变化、低白蛋白血症和围术期内并发症发生率以及术后1年膝关节功能恢复情况。结果与结论:①与分期手术相比,选择同期全膝关节置换的手术时间和住院时长更短,住院费用更低,但是患者发生贫血和低蛋白血症的概率较大,患者疼痛更明显;②术后1年随访时,同期组可以获得更高的生活质量心理评分和遗忘指数,但两组患者术后膝关节活动度、HSS评分、WOMAC骨关节炎指数和Feller髌骨评分的差异无显著性意义;③结论:同期双侧全膝关节置换将手术和麻醉限制在单一事件中,促进双膝的对称康复及减少住院时间,降低患者和医院成本,改善膝关节功能,主观感觉更佳,是治疗双膝关节炎的一种安全有效的方法。

BACKGROUND:The choice between simultaneous and staged bilateral total knee arthroplasty remains a matter of debate in orthopaedic practice when primary knee osteoarthritis patients require surgical treatment of both knees.OBJECTIVE:To evaluate the safety and efficacy of two different surgical options for bilateral knees by comparing the differences in perioperative outcomes and early functional improvement between simultaneous bilateral total knee arthroplasty and staged bilateral total knee arthroplasty,with the aim of providing a reference for clinical decision making.METHODS:Data of patients who received bilateral total knee arthroplasty for knee osteoarthritis at the Department of Orthopedics,Zhongshan Hospital of Dalian University from January 2016 to January 2021 were retrospectively analyzed.The patients were divided into simultaneous(n=82)and staged(n=75)groups.The preoperative general information,length of hospital stay,hospital costs,length of surgery,blood transfusion,pain visual analogue scale score,perioperative hemoglobin changes,incidence of hypoalbuminemia and perioperative complication rates,and recovery of joint function 1 year after surgery were compared between the two groups.RESULTS AND CONCLUSION:(1)Compared with the staged group,the simultaneous group had shorter operative time and length of stay,lower hospital costs,higher incidence of anemia and hypoproteinemia,and more obvious pain.(2)The simultaneous group had higher psychological quality of life scores and forgetfulness index at the one-year postoperative follow-up.However,there were no significant differences in postoperative knee motion range,HSS scores,WOMAC index,and Feller patella scores between the two groups.(3)It is concluded that simultaneous bilateral total knee arthroplasty can limit surgery and anesthesia to a single event,promote symmetrical rehabilitation of both knees and reduce hospital stay,reduce costs for patients and hospitals,improve knee function and feel better,which is a safe and effective method for the treatment of knee arthritis.