第一临床医学院知识库

目的：分析比较对于膝关节OA（osteoarthritis，OA）患者双侧同期和分期行TKA(total knee arthroplasty， TKA)的手术后并发症和临床效果，并探讨同期行双侧TKA的安全可行性。

方法：收集2014年1月—2016年3月期间在我院接受双侧TKA的70例双侧膝关节重度骨性关节炎患者的临床资料，将其中34例双侧同期行TKA患者纳入同期组，其中36例双侧分期行TKA患者纳入分期组，分析比较两组患者的一般资料、术前合并疾病情况、术中术后的出血量及输血量、手术并发症、手术前及手术后一年膝关节HSS评分及ROM（range of motion，ROM）、住院时间及费用等指标。

结果：两组患者在一般资料、手术前合并症发生率以及手术并发症发生率方面差异无统计学意义（P>0.05）；同期组住院时间短于分期组，结果存在统计学意义（P<0.05）；分期组住院总费用多于同期组，但出血量及输血量少于同期组，均存在统计学上意义（P<0.05）；两组患者手术前、手术后一年膝关节HSS评分及ROM相比，均不具有统计学意义（P>0.05）。

结论：对于双侧膝关节OA患者，双侧同期与双侧分期TKA具有相同的临床疗效，且不增加手术的风险及并发症发生率，具有缩短患者住院时间、节省住院花费、减少患者痛苦等多方面优势。对于双侧膝关节OA患者，全面评估患者基本状况，在基本状况相对较好的条件下，可以双侧同期行TKA。

Objective: To compare postoperative complications and clinical efficacy of simultaneous-bilateral and staged-bilateral total knee arthroplasty（TKA）in the treatment of osteoarthritis of the knee joint ,and explore the feasibility of simultaneous-bilateral TKA

Methods: a total of 70 cases with severe bilateral knee osteoarthritis received bilateral TKA from January 2014 to March 2016 in our hospital were collected. 34 cases of simultaneous bilateral TKA were divided into concurrent group and 36 cases of staged bilateral TKA were divided into staged group.the general information of patients, preoperative complications, perioperative bleeding and blood transfusion, postoperative complications, HSS score of knee joint and ROM before operation and one year after operation,the hospitalization time and cost indicators of the two groups were compared and analyzed.

Result: No significant difference were found with the preoperative general information of the two groups .There was no statistically significant difference in the incidence of preoperative complications and the incidence of surgical complications (P>0.05) ,  the period of hospitalization time of the concurrent group is shorter than the staged group, the difference was statistically significant (P<0.05) , the total hospitalization expense of the staged group is more than the concurrent group, but the amount of bleeding and blood transfusion less than the concurrent group, the differences were statistically significant (P<0.05), the preoperative HSS scores and ROM of the two groups, the HSS scores and ROM of one year after knee arthroplasty were respectively compared, the difference was not statistically significant (P>0.05).

Conclusion: In terms of efficacy , the simultaneous and the staged bilateral TKA have the same clinical effect and does not increase the risk of surgery and the incidence of complicationsin in the treatment of osteoarthritis of the knee joint, with the advantages of reducing the length of hospital stay, saving the cost of hospitalization, reducing the pain of patients etc.., so for patients of bilateral osteoarthritis of the knee joint, a comprehensive assessment of the basic situation of patients, if the basic situation is relatively good, simultaneous bilateral knee arthroplasty can be given.