CAJ | 학술논문

目的比较同期和分期双侧全膝关节置换术(total knee arthroplasty,TKA)治疗双侧膝关节骨关节炎的临床疗效及安全性.方法回顾性分析2005年3月至2012年3月因双膝骨关节炎行双侧全膝关节置换术的119例患者,男14例,女105例;年龄30～81岁,平均(65.23±6.33)岁.根据不同的手术方式将患者分为同次麻醉下的同期双侧TKA组、同一住院周期的分次双侧TKA组及不同住院周期内的分期双侧TKA组.患者均使用相同类型的关节假体(LPS-Flex,Zimmer,美国),由同一组医生完成手术.比较三组患者术前基本情况:年龄、身高、体重指数和术前合并症;围手术期情况:术前血色素和手术时间、术后引流量、术后输血量、住院时间和治疗总费用;术后疗效:美国特种外科医院(Hospital for SpecialSurgery,HSS)膝关节评分、西安大略和麦克马斯特大学(The Western Ontario and McMaster Universities Arthritis Index,WOMAC)骨关节炎指数、关节活动度和并发症发生情况.结果三组患者性别构成、体重指数、术前血红蛋白的差异无统计学意义,但同期双侧TKA组在接受手术时年龄更轻、术前合并疾病的发生率更低.术后三组患者HSS膝关节评分、WOMAC骨关节炎指数、膝关节活动度的差异均无统计学意义;同期双侧TKA组虽然手术时间更短、住院时间更短、住院总费用更低,但术后引流量、输血量及术后并发症发生率均明显高于另外两组.结论由于同期双侧TKA手术创伤大、术后并发症多,且可能导致假体周围感染风险增加,选择该术式应慎重.
목적 비교동기화분기쌍측전슬관절치환술(total knee arthroplasty,TKA)치료쌍측슬관절골관절염적림상료효급안전성.방법 회고성분석2005년3월지2012년3월인쌍슬골관절염행쌍측전슬관절치환술적119례환자,남14례,녀105례;년령30～81세,평균(65.23±6.33)세.근거불동적수술방식장환자분위동차마취하적동기쌍측TKA조、동일주원주기적분차쌍측TKA조급불동주원주기내적분기쌍측TKA조.환자균사용상동류형적관절가체(LPS-Flex,Zimmer,미국),유동일조의생완성수술.비교삼조환자술전기본정황:년령、신고、체중지수화술전합병증;위수술기정황:술전혈색소화수술시간、술후인류량、술후수혈량、주원시간화치료총비용;술후료효:미국특충외과의원(Hospital for SpecialSurgery,HSS)슬관절평분、서안대략화맥극마사특대학(The Western Ontario and McMaster Universities Arthritis Index,WOMAC)골관절염지수、관절활동도화병발증발생정황.결과 삼조환자성별구성、체중지수、술전혈홍단백적차이무통계학의의,단동기쌍측TKA조재접수수술시년령경경、술전합병질병적발생솔경저.술후삼조환자HSS슬관절평분、WOMAC골관절염지수、슬관절활동도적차이균무통계학의의;동기쌍측TKA조수연수술시간경단、주원시간경단、주원총비용경저,단술후인류량、수혈량급술후병발증발생솔균명현고우령외량조.결론 유우동기쌍측TKA수술창상대、술후병발증다,차가능도치가체주위감염풍험증가,선택해술식응신중.
Objective To compare the clinical safety and efficacy of simultaneous bilateral total knee arthroplasty (TKA) and staged bilateral TKA in treatment of both knee osteoarthritis.Methods A total of 119 patients (14 males,105 females) with both knee osteoarthritis who underwent TKA from March 2005 to March 2012 were retrospectively analyzed.Their ages ranged from 30 to 81 years with the average age of 65.23±6.33 years.The patients were divided into three groups according to different treaments:simultaneous bilateral TKA group,staged bilateral TKA group during the same hospitalization period and staged bilateral TKA group in two separate hospitalization periods.All the procedures were performed by the same surgeons and the same type of prostheses (LPS-Flex,Zimmer,US) were implanted.Differences of preoperative factors (age,height,body mass in dex and complications),treatment factors (preoperative hemoglobin,operation time,drainage volume,blood transfusion volume,total hospitalization time and total hospitalization costs) and postoperative curative effects (HSS scores,WOMAC scores and ROM)among three groups were compared.The analysis of viariace,LSD-t test and x2 test were used for data analysis.Results The differences of gender composition,body mass index,preoperative hemoglobin were not statistically significant among three groups (P＞0.05).The patientsin simultaneous bilateral TKA group were younger,and havelower incidence ofpreoperative complications (P＜0.05).The differences of post-operative HSS scores,WOMAC scores and ROM were not statistically significant among the three groups (P＞0.05).Although the total hospitalization time,operation time were shorter,and the hospitalization costs were significant ly lower in simultaneous bilateral TKA group,the total drainage volume,the total blood transfusion volume and incidence of postoperative complication rate were higher in this group than those of the other two grops (P＜0.05).Conclusion Due to great impact on patients' physiological conditions,more postoperative complication occurrence and high risk of periprosthetic infection,the decision of simultaneous bilateral TKA should be made cautiously.