同期双侧与分期双侧关节置换治疗膝骨关节炎的对照研究

摘要

Objective:To compare the safety and clinical efficacy following simultaneous versus staggered bilateral total knee arthroplasty in treatment of osteoarthritis. Methods: Total 43 patients underwent total knee arthroplasty between April 2010 and June 2013, which included 20 simultaneous bilateral total knee arthroplasties and 23 staggered bilateral total knee arthroplasty. The preoperative and postoperative range of motion(ROM), visual analogue scale(VAS), postoperative complications, the Knee Society Score(KSS), Western Ontario and McMaster Universities osteoarthritis index(WOMAC) were compared. Results:Preoperatively there were no statistically significant significances between the 2 groups in the age, gender, body mass index(BMI), ROM, muscle strength, VAS and so on(P>0.05). There were no significances between two groups in postoperative complications, postoperative ROM, VAS at 1 year follow-up, except preoperative. No significantly differences were found with regard to postoperative KSS at 1 year follow-up. Knee Society function scores were higher in the simultaneous bilateral group. There were no statistically significances in the KSS and WOMAC between the simultaneous bilateral total knee arthroplasties group and the staggered bilateral total knee arthroplasty group at preoperation, 6 and 12 months postoperatively( P>0.05). Conclusion: It was concluded that simultaneous bilateral total knee arthroplasty is similar to that in the staggered bilateral total knee arthroplasty with carefully selecting patient and fully completing preoperative evaluation. And the bilateral total knee arthroplasty is superior to the hospitalization time, and avoiding the second surgery.%目的：比较同期双侧与分期双侧关节置换术治疗膝骨关节炎的疗效和安全性。方法：回顾分析2010年4月—2013年6月全膝关节置换术患者43例，分为同期双侧膝关节置换组(同期组, n=20)和分期双侧膝关节置换组(分期组, n=23)，分别对两组患者置换前后的关节活动度(range of motion, ROM)、疼痛视觉模拟评分(visual analogue scale, VAS)、术后并发症、美国膝关节协会评分(American Knee Society Score,简称KSS评分)系统及西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities osteoarthritis index, WOMAC指数)进行比较分析。结果：两组患者置换后1年随访，置换后ROM、术后VAS评分差异无统计学意义(P＞0.05)，但与术前相比改善明显(P<0.05)；术后并发症发生率差异亦无统计学意义(P＞0.05)；术后1年KSS临床评分两组间差异无统计学意义，同期置换组KSS功能评分高于分期置换组(P<0.05)；两组术前、6个月、1年的WOMAC指数比较差异均无统计学意义(P＞0.05)。结论：同期双膝关节置换和分期双膝关节置换具有相同的临床效果和安全性，同时同期双膝关节置换具有减少住院时间、次数，并避免了二次手术的优势。