一期雙側全髖關節置換術與單側全髖關節置換術的臨床比較研究

祝 鈞 林祥波 劉 博 祝云利 吳海山

[摘要] 目的 本研究旨在評估及對比一期雙側全髖關節置換術(bilateral total hip arthroplasty ,BTHA)與單側全髖關節置換術(unilateral total hip arthroplasty, UTHA)在并發癥方面存在的差異。方法 選擇100位連續的一期雙髖關節置換術(50患者100個髖關節)及單側THA(50患者50髖關節),分別測定術后并發癥、圍手術期血紅蛋白量、總輸血量、住院時間等指標。結果 兩組患者在90天的死亡率方面無統計學差異。BTHA組患者需要更多異體輸血,且有效血紅蛋白數更低。BTHA患者術后貧血并發癥稍高。結論 對無嚴重基礎疾病的患者行一期BTHA,其并發癥是可接受的。

[關鍵詞] 全髖關節置換術一期; 雙側; 單側; 并發癥

[中圖分類號] R687.4[文獻標識碼] A[文章編號] 1004-8650(2009)06-01-03

[Abstract] Objective The aim of this study was to evaluate and compare the morbidity profile of patients undergoing 1-stage bilateral uncemented total hip arthroplasty (BTHA) vs unilateral uncemented THA (UTHA). Methods One hundred consecutive patients undergoing 1-stage bilateral THA (50 patients, 100 hips) and unilateral THA (50 patients,50hips) were recruited and prospectively followed. Postoperative complications,the amount of perioperativ hemoglobins ,total blood transfusion , hospital times were recorded and followed up.Results There were no statistically significant differences in 90-day mortality. Bilateral THA patients required more autologous and allogenic blood transfusionand had lower hemoglobin than UTHA patients. Patients undergoing BTHA should expect a slightly higher incidence of complications related to postoperative anemia. Conclusion It is safe for patients who had no several comorbidities to be opereted with 1-stage BTHA,with an acceptable complications.

[Key words] total hip arthroplasty1-stage;bilateral;unilateral;complications

全髖關節置換術的安全性已得到公認,對于晚期髖關節炎患者特別是年輕患者是比較合理的選擇,可縮短年輕患者殘疾時間及康復時間,并可降低手術費用[1,2]。近年來雙側癥狀性髖關節炎手術數量呈現上升趨勢[7],一些研究認為一期雙側髖關節置換術增加了手術并發癥[3,4],Berend etal[3]在一項回顧性研究中發現BTHA患者相對于單側全髖關節置換術(unilateral total hip arthroplasty,UTHA)患者,其肺部并發癥增加了將近2倍。另一些研究卻認為手術并發癥并未增加[6,8],并可有效降低雙側髖關節炎患者的疼痛,保存患髖功能,且不增加手術風險[1,2,5,10]。

本前瞻性研究旨在評估及對比一期BTHA與UTHA在并發癥方面存在的差異。

1資料與方法

1.1一般資料

所有患者均為2004年7月-2005年6月期間我院連續的雙側髖關節炎保守治療無效的初次全髖關節置換術的患者。……