分期和同期全膝关节置换手术的临床效果观察

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摘要目的探讨同期和分期全膝关节置换术治疗双膝骨关节炎患者的临床效果。方法选择2013年6月至2015年1月我科行双膝关节置换手术的患者66 例，其中男性20 例，女性46 例，年龄61～78岁，平均(67.3±5.1)岁。同期置换治疗患者36 例，分期置换治疗患者30 例，比较两组患者的的临床效果。结果同期置换组在手术时间、住院时间上存在着优势，而分期置换组则在术后引流量、术后血红蛋白和术后输血量存在着优势，差异具有统计学意义(P＜0.01)。同期置换组在术后白细胞、C反应蛋白和血沉方面要高于分期置换组，差异具有统计学意义(P＜0.05或P＜0.01)。在膝关节功能上(膝关节HSS评分)，两组差异未见统计学意义(P＞0.05)。在并发症方面，同期全膝关节置换术后发热和并发症总数方面明显偏多，差异具有统计学意义(P＜0.05)。两组病例在手术时间、住院时间、术后引流量、术后血红蛋白和术后输血量等方面差异有统计学意义(P＜0.01)，但在膝关节功能上(膝关节HSS评分)两组差异未见统计学意义(P＞0.05)。结论分期和同期全膝关节置换在手术治疗效果上各有优势，但远期随访在膝关节功能方面差异不明显。由此可见双侧膝骨关节炎可根据患者的具体情况采用同期和分期置换术手术。同期和分期全膝关节置换在术后近期治疗效果上各有优势，但研究发现膝关节功能远期随访未见明显差异。对于双膝关节置换的患者，应根据患者的具体情况采用适合的手术方式，远期均能达到满意的治疗效果。

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关键词 ：骨关节炎, 全膝关节置换, 膝关节

Abstract：Objective To investigate the clinical effect of simultaneous bilateral total knee arthroplasty and staged bilateral total knee arthroplasty in the treatment of patients with osteoarthritis of the knee.Methods From June 2013 to January 2015，66 cases of patients with bilateral knee replacement surgery in our department were selected.This study included 36 cases of simultaneous bilateral total knee arthroplasty and 30 cases of staged bilateral total knee arthroplasty.The treatment and clinical effect of two groups were retrospectively analyzed.Results There were advantages in operation time and hospital stays in the the group of simultaneous bilateral total knee arthroplasty (both P＜0.01)，and there were advantages in the staged replacement group in the postoperative blood volume，postoperative hemoglobin and blood transfusion (both P＜0.01).The simultaneous group had higher leukocyte，C-reactive protein(CRP) and erythrocyte sedimentation rate (ESR) than replacement group，the difference has statistical significance (P＜ 0.05 or P＜0.01).In knee function (HSS score)，there was no significant difference between the two groups (P＞0.05).In terms of complications，fever and the number of complications after simultaneous group was significantly more than staged group，and the difference was statistically significant (P＜ 0.05).Conclusion The two groups in the treatment effect have different advantages in the short term follow-up，but in the long term follow-up of knee joint function，there were not significantly different.The use of the same simultaneous and staged replacement surgery，postoperative recovery are more satisfied with the results.

Key words： osteoarthritis total knee arthroplasty knee

通讯作者: 李朝顶

作者简介: 时超(1972－ )，男，副主任中医师，南京中医药大学附属徐州市中医院骨伤科，221003

引用本文:

时超，李朝顶*，罗仲伟，陈继平，谭亮. 分期和同期全膝关节置换手术的临床效果观察[J]. 实用骨科杂志, 2016, 22(12): 1069-1076.
Shi Chao，Li Zhaoding，Luo Zhongwei， et al. Simultaneous Bilateral and Staged Bilateral Total Knee Arthroplasty in Treatment of Knee Osteoarthritis. sygkzz, 2016, 22(12): 1069-1076.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2016/V22/I12/1069

［1］Leonard L，Williamson DM，Ivory JP，et al.An evaluation of the safety and efficacy of simultaneous bilateral total knee arthroplasty［J］.J Arthroplasty，2003，18(8)：972-978.
［2］Kim S，Meehan JP，White R.Operative risk of staged bilateral knee arthroplasty is underestimated in retrospective studies［J］.J Arthroplasty，2011，26(8)：1198-1204.
［3］Insall JN，Ranawat CS，Aglietti EA，et al.Companison of fourmodels of total knee replacement prostheses［J］.J Bone Joint Surg(Am)，1976，58(6)：754-765.
［4］Mizner RL.Emerging perspectives related to quadriceps central activation deficits in patients with total knee arthroplasty［J］.Exerc Sport Sci Rev，2012，40(2)：61-62.
［5］Dy CJ，Franco N，Ma Y，et al.Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis.A Meta-analysis［J］.Knee Surg Sports Traumatol Arthroscopy，2012，20(11)：2174-2190.
［6］Bruyère O，Ethgen O，Neuprez A，et al.Health-related quality of life after total knee or hip replacement for osteoarthritis：a 7-year prospective study［J］.Arch Orthop Trauma Surg，2012，132(11)：1583-1587.
［7］房小文，薛峰，盛晓文，等.单髁置换与全膝关节置换治疗内侧胫股关节炎早中期疗效比较［J］.实用骨科杂志，2015，21(6)：497-499.
［8］米尔阿里木·木尔提扎，赵巍，王利，等.人工全膝关节置换术对患者躯体平衡性影响的研究［J］.实用骨科杂志，2015，21(7)：610-613.
［9］Spicer E，Thomas GR，Rumble EJ.Comparison of the major intraoperative and postoperative complications between unilateral and sequential bilateral total knee arthroplasty in a high-volume community hospital［J］.Can J Surg，2013，56(5)：311-317.
［10］Odum SM，Troyer JL，Kelly MP，et al.A cost-utility analysis comparing the cost-effectiveness of simultaneous and staged bilateral total knee arthroplasty［J］.J Bone Joint Surg(Am)，2013，95(16)：1441-1449.
［11］Kim MH，Nahm FS，Kim TK，et al.Comparison of postoperative pain in the first and second knee in staged bilateral total knee arthroplasty：clinical evidence of enhanced pain sensitivity after surgical injury［J］.Pain，2014，155(1)：22-27.
［12］Poultsides LA，Ghomrawi HM，Lyman S，et al.Change in preoperative expectations in patients undergoing staged bilateral primary total knee or total hip arthroplasty［J］.J Arthroplasty，2012，27(9)：1609-1615.
［13］Haanstra TM，van den Berg T，Ostelo RW，et al.Systematic review：do patient expectations influence treatment outcomes in total knee and total hip arthroplasty?［J］.Health Qual Life Outcomes，2012，18(10)：152.
［14］Chahal GS，Saithna A，Brewster M，et al.A comparison of complications requiring return to theatre in hip and knee arthroplasty patients taking enoxaparin versus rivaroxaban for thromboprophylaxis［J］.Ortop Traumatol Rehabil，2013，15(2)：125-129.
［15］MerleVincent F，Couris CM，Schott AM，et al.Factors predicting patient satisfaction 2 years after total knee arthroplasty for osteoarthritis［J］.Joint Bone Spine，2011，78(4)：383-386.
［16］Memtsoudis SG，Mantilla CB，Parvizi J，et al.Have bilateral total knee arthroplasties become safer? A population-based trend analysis［J］.Clin Orthop Relat Res，2013，471(1)：17-25.
［17］Jenny JY，Trojani C，Prudhon JL，et al.Simultaneous bilateral total knee arthroplasty.A multicenter feasibility study［J］.Orthop Traumatol Surg Res，2013，99(2)：191-195.