分期和同期全膝关节置换手术的临床效果观察

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。%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 ar-throplasty.The treatment and clinical effect of two groups were retrospectively analyzed.Results There were advanta-ges 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 hemo-globin 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 recov-ery are more satisfied with the results.