肥胖患者双组同时双侧全膝关节置换术的围手术期安全性
Perioperative safety of two-team simultaneous bilateral total knee arthroplasty in the obese patient.
作者信息
Taylor Benjamin C, Dimitris Craig, Mowbray John G, Gaines Steven T, Steensen Robert N
机构信息
Department of Orthopaedic Surgery, Mount Carmel Medical Center, MSB 3rd Floor, 793 W, State Street, Columbus, Ohio, 43222, USA.
出版信息
J Orthop Surg Res. 2010 Jun 17;5:38. doi: 10.1186/1749-799X-5-38.
BACKGROUND
Although the rates of perioperative morbidity and mortality with simultaneous bilateral total knee arthroplasty remain a concern, multiple studies have shown the procedure to be safe in selected patient populations. Evidence also remains mixed regarding the outcomes of total knee arthroplasty in obese patients. The purpose of this paper is to compare the rates of perioperative morbidity and mortality in consecutive obese patients undergoing two-team simultaneous bilateral total knee arthroplasty and unilateral total knee arthroplasty.
METHODS
The records on all two-team simultaneous total knee arthroplasties and unilateral total knee arthroplasties from October 1997 to December 2007 were reviewed. A total of 151 patients with a body mass index (BMI) >30 undergoing two-team simultaneous total knee arthroplasty and 148 patients with a BMI >30 undergoing unilateral total knee arthroplasty were retrospectively reviewed and analyzed to determine perioperative morbidity and mortality as well as one-year mortality rates.
RESULTS
Preoperative patient characteristics did not show any significant differences between groups. The simultaneous bilateral group had significantly longer operative times (127.4 versus 112.7 minutes, p < 0.01), estimated blood loss (176.7 versus 111.6 mL, p = 0.01), percentage of patients requiring blood transfusion (64.9% versus 13.9%, p < 0.01), length of hospital stay (3.72 versus 3.30 days, p < 0.01), and percentage of patients requiring extended care facility usage at discharge (63.6% versus 27.8%, p < 0.01). No significant difference between unilateral and bilateral groups was seen in regards to total complication rate, major or minor complication subgroup rate, or any particular complication noted. Doubling the variables in the unilateral group for a staged total knee arthroplasty scenario did create significant increases over the simultaneous data in almost every data category.
CONCLUSIONS
Two-team simultaneous total knee arthroplasty appears to be safe in obese patients, with similar complication rates as compared to unilateral procedures. Two-team simultaneous total knee arthroplasty also appears to have potential benefits over a staged procedure in the obese patient, although more study is required regarding this topic.
背景
尽管同期双侧全膝关节置换术的围手术期发病率和死亡率仍令人担忧，但多项研究表明，该手术在特定患者群体中是安全的。关于肥胖患者全膝关节置换术的结果，证据也存在分歧。本文的目的是比较连续接受两组同时进行双侧全膝关节置换术和单侧全膝关节置换术的肥胖患者的围手术期发病率和死亡率。
方法
回顾了1997年10月至2007年12月期间所有两组同时进行的全膝关节置换术和单侧全膝关节置换术的记录。对151例体重指数（BMI）>30且接受两组同时进行全膝关节置换术的患者以及148例BMI>30且接受单侧全膝关节置换术的患者进行回顾性分析，以确定围手术期发病率和死亡率以及一年死亡率。
结果
术前患者特征在两组之间未显示出任何显著差异。同期双侧组的手术时间明显更长（127.4分钟对112.7分钟，p<0.01），估计失血量更多（176.7毫升对111.6毫升，p = 0.01），需要输血的患者百分比更高（64.9%对13.9%，p<0.01），住院时间更长（3.72天对3.30天，p<0.01），出院时需要使用延长护理设施的患者百分比更高（63.6%对27.8%，p<0.01）。在总并发症发生率、主要或次要并发症亚组发生率或任何特定并发症方面，单侧组和双侧组之间未观察到显著差异。在分期全膝关节置换术的情况下，将单侧组的变量加倍确实在几乎每个数据类别中都比同期数据有显著增加。
结论
两组同时进行全膝关节置换术在肥胖患者中似乎是安全的，与单侧手术相比并发症发生率相似。两组同时进行全膝关节置换术在肥胖患者中似乎也比分阶段手术有潜在益处，尽管关于这个主题还需要更多研究。
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