文章摘要
蒲川成,冉学军,覃勇志,余江.同期和分期全膝关节置换术治疗双侧膝骨关节炎的比较.骨科,2017,8(4):278-282
同期和分期全膝关节置换术治疗双侧膝骨关节炎的比较
Safety, economy and efficacy of simultaneous or staged bilateral total knee arthroplasty in treatment of bilateral knee osteoarthritis
投稿时间: 2016-11-07  
DOI:10.3969/j.issn.1674-8573.2017.04.006
中文关键词: 骨关节炎  关节成形术,置换,膝  对比研究
英文关键词: Osteoarthritis  Arthroplasty, replacement, knee  Comparative study
基金项目:
作者单位E-mail
蒲川成 638500 四川广安四川大学华西广安医院骨关节科 996588709@qq.com 
冉学军 638500 四川广安四川大学华西广安医院骨关节科  
覃勇志 638500 四川广安四川大学华西广安医院骨关节科  
余江 638500 四川广安四川大学华西广安医院骨关节科  
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中文摘要:
      目的 探讨和比较同期全膝关节置换术和分期全膝关节置换术分别治疗双侧膝骨关节炎的安全性、经济性和成效性。方法 选取2011年5月至2015年5月于我院接受双侧膝关节初次置换手术的108例双侧膝骨关节炎病人,根据手术方案的不同分为两组:同期全膝关节置换术治疗病人46例(同期组),分期全膝关节置换术治疗病人62例(分期组)。收集反应两组病人安全性、经济性和成效性的相关指标进行对比分析。结果 同期组病人和分期组病人在术后病死率、二次手术率、术后30 d再次入院率、并发症发生率等显性安全风险指标比较,差异均无统计学意义(均P>0.05);同期组病人术后血红蛋白含量、白蛋白水平、总住院时间均低于分期组,而出血量、引流量、术后输血量等指标高于分期组,差异均有统计学意义(均P<0.05)。同期组病人的平均住院费用(不含假体费用)低于分期组,差异有统计学意义(P<0.05)。同期组和分期组在术后3个月、1年的膝关节功能用美国特种外科医院(Hospital for Special Surgery, HSS)膝关节功能评定标准评分、膝关节活动度、屈曲挛缩度、疼痛视觉模拟量表(visual analogue scale, VAS)评分等方面比较,差异均无统计学意义(均P>0.05)。结论 对于初次行双侧全膝关节置换的膝骨关节炎病人,在严格的围手术期管理和谨慎评估下,同期双侧置换与分期置换在手术的安全性和成效性上并无显著性差异,但在经济性上前者显著优于后者。
英文摘要:
      Objective To comparatively analyze simultaneous or staged bilateral total knee arthroplasty (TKA) in treatment of bilateral knee osteoarthritis from aspects of safety, economy and efficacy. Methods One hundred and eight patients suffering from severe bilateral knee osteoarthritis undergoing TKA in our hospital from May 2011 to May 2015 were divided into simultaneous bilateral TKA group (SitBTKA group, n=46) and staged bilateral TKA group (StBTKA group, n=62). Variables reflecting safety, economy and effects were set up and data were collected and analyzed. Results There were no significant differences in the postoperative mortality, revision rates, the rate of postoperative 30-d re-admission and the incidence of postoperative complications between two group (P>0.05). The levels of postoperative hemoglobin and albumin, and total hospitalization time in SitBTKA group were significantly reduced as compared with those in StBTKA group, and the bleeding volume, drainage volume, and postoperative blood transfusion volume were significantly increased in SitBTKA group as compared with those in StBTKA group (all P<0.05). The average hospitalization cost of patients in the SitBTKA group was significantly less than that in the StBTKA group (P<0.05). There were no significant differences in the postoperative HSS score, range of motion, flexion contracture and pain score between two groups at 3rd month and 1st year after operation (P>0.05). Conclusion With the same surgical management, simultaneous or staged bilateral TKA in the treatment of bilateral knee osteoarthritis had the same safety and efficacy, however the economy was better for simultaneous TKA.
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