对于 ASA 评分为 1-3 分的患者，如果由高容量外科医生进行手术，双侧同期膝关节置换术在早期结果和并发症发生率方面与分期双侧膝关节置换术相当：一项 127 例回顾性队列研究。
Bilateral simultaneous knee arthroplasty shows comparable early outcome and complication rate as staged bilateral knee arthroplasty for patients scored ASA 1-3 if performed by a high-volume surgeon: a retrospective cohort study of 127 cases.
机构信息
Centre for Musculoskeletal Surgery, Charité-University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany.
OCM Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany.
出版信息
Arch Orthop Trauma Surg. 2024 Jan;144(1):417-424. doi: 10.1007/s00402-023-05078-4. Epub 2023 Oct 9.
BACKGROUND AND PURPOSE
The study compares early outcomes after simultaneous and staged knee arthroplasty in patients with bilateral knee osteoarthritis (OA) to evaluate whether simultaneous bilateral TKA shows comparable early outcomes and complication rates to staged bilateral TKA.
METHODS
A retrospective cohort study including all patients scheduled for primary TKA for bilateral knee OA (n = 127) was conducted. Patients received either simultaneous (n = 53, 41.7%) or staged (n = 74, 58.3%) bilateral TKA by a single, high-volume surgeon-depending on their individual preference. Demographic data, haemoglobin drop (Hb), length of stay (LOS), operation time, 30-day complication rate and achievement of rehabilitation key points were evaluated.
RESULTS
There was no difference between the groups concerning age, sex, BMI or complication rate. ASA scoring was better in the simultaneous group [2.2, (15.1% ASA 1, 49.1% ASA 2, 35.8% ASA 3) vs. 2.4 (2.7% ASA 1, 51.4% ASA 2, 45.9% ASA 3)]. Average LOS was 7.8 ± 2.1 days for simultaneous TKA, 7.4 ± 1.7 days for single procedure of staged group (p < 0.453) and 14.7 ± 3.1 days if combined (p < 0.001). Cumulative Hb loss was significantly higher in the staged group (3.8 ± 1.2 g/dl vs. 2.4 ± 0.8 g/dl, p < 0.001). Detailed comparison of early outcome parameters between staged and simultaneous procedure depending on ASA score only revealed slightly slower assessment of stairs (p < 0.001) and increased Hb drop per surgery in case of simultaneous procedure (p < 0.011) if ASA score was ≥ 2. Only patients scored ASA 3 demonstrated a significant longer LOS per procedure in simultaneous group (8.5 ± 2.4 vs.7.3 ± 1.6 days, p = 0.034).
INTERPRETATION
Simultaneous bilateral TKA results in comparable early outcome and complication rate than staged bilateral procedure-even for patients scored ASA 3.
LEVEL OF EVIDENCE
Level IV.
背景与目的
本研究比较了双侧膝关节骨关节炎（OA）患者同期和分期膝关节置换术后的早期结果，以评估同期双侧全膝关节置换术（TKA）是否与分期双侧 TKA 具有可比的早期结果和并发症发生率。
方法
进行了一项回顾性队列研究，纳入了所有计划接受双侧膝关节 OA 初次 TKA 的患者（n=127）。根据患者的个人偏好，由一位高容量的单名外科医生为他们施行同期（n=53，41.7%）或分期（n=74，58.3%）双侧 TKA。评估了患者的人口统计学数据、血红蛋白下降（Hb）、住院时间（LOS）、手术时间、30 天并发症发生率和康复要点的达成情况。
结果
两组在年龄、性别、BMI 或并发症发生率方面无差异。同期组的 ASA 评分更好[2.2（15.1%ASA1，49.1%ASA2，35.8%ASA3）vs.2.4（2.7%ASA1，51.4%ASA2，45.9%ASA3）]。同期 TKA 的平均 LOS 为 7.8±2.1 天，分期组单次手术的 LOS 为 7.4±1.7 天（p<0.453），联合手术的 LOS 为 14.7±3.1 天（p<0.001）。分期组的累积 Hb 丢失明显更高（3.8±1.2 g/dl vs.2.4±0.8 g/dl，p<0.001）。仅根据 ASA 评分对分期和同期手术的早期结果参数进行详细比较发现，同期手术时楼梯评估速度较慢（p<0.001），每例手术的 Hb 下降量增加（p<0.011），如果 ASA 评分≥2。仅 ASA 评分 3 的患者在同期组中每例手术的 LOS 明显更长（8.5±2.4 vs.7.3±1.6 天，p=0.034）。
结论
同期双侧 TKA 的早期结果和并发症发生率与分期双侧手术相当——即使是 ASA 评分 3 的患者也是如此。
证据水平
IV 级。
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