Jankiewicz J J, Sculco T P, Ranawat C S, Behr C, Tarrentino S
Hospital for Special Surgery, New York, NY 10021.
Clin Orthop Relat Res. 1994 Dec(309):94-101.
This retrospective study reviews 155 bilateral total knee arthroplasties, of which 99 were simultaneous and 56 staged. The results revealed that blood loss and postoperative blood requirements were higher in the simultaneous group, with 60% requiring homologous blood. The simultaneous approach was advantageous for a reduction in hospital stay, physical therapy, and resultant hospital costs. The complication rate was similar for both groups when examining pulmonary embolism, wound problems, infection, deep venous thrombosis, and death. The authors' incidence of fat embolism syndrome was similar for both groups but higher than that reported in the literature. Attempts with present preoperative evaluation cannot predict the incidence of fat embolism syndrome. A more invasive preoperative workup may identify those at risk. Preoperative marrow stimulants and the use of reinfused blood may eliminate the use of homologous blood in the simultaneous group.
这项回顾性研究评估了155例双侧全膝关节置换术，其中99例为同期手术，56例为分期手术。结果显示，同期手术组的失血量和术后输血需求量更高，60%的患者需要输注同源血。同期手术方式有利于缩短住院时间、减少物理治疗以及降低住院费用。在检查肺栓塞、伤口问题、感染、深静脉血栓形成和死亡情况时，两组的并发症发生率相似。两组的脂肪栓塞综合征发生率相似，但高于文献报道。目前的术前评估方法无法预测脂肪栓塞综合征的发生率。更具侵入性的术前检查可能会识别出有风险的患者。术前使用骨髓刺激剂和回输自体血可能会使同期手术组不再需要输注同源血。
