同期与分期行双侧全髋关节置换术的短期临床结果分析

发布时间：2018-04-23 17:05

本文选题：髋关节置换术 + 功能恢复　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的对于双侧髋关节病变且均有手术指征的患者，在治疗计划上采取同期行双侧全髋关节置换术（total hip arthroplasty，THA）或是分期行双侧THA仍存在争议。因此，鉴于这方面的争议，本次研究回顾性分析了同期及分期行双侧THA的患者，对同期与分期行双侧THA的临床疗效及安全性进行比较。以为双侧髋关节病变是否可选择同期双侧THA提供参考。方法对2008年1月-2010年1月我院美国麻醉医师协会(AmericanSociety ofAnesthesiologists,ASA)术前分级≤3级、双侧髋关节病变经非手术治疗无效后行双侧THA的63例患者纳入研究，，其中58例患者在研究中获得随访。其中，同期组29例患者，为同期行双侧THA；分期组29例患者，为分期行双侧THA。随访及回顾性分析两组患者。随访自手术后3个月开始，随访期限为术后2年，统计分析两组患者的手术总时间、术中及术后的总失血量、总输血量、住院时间及治疗费用、术后双下肢肢长差异、术前及术后1年Harris评分和牛津髋关节量表评分（the Oxford Hip Score，OHS）、围手术期并发症。结果术后两组患者在随访期限内均未出现切口感染（infection ofincision）、深静脉血栓（deep venous thrombosis，DVT）、人工关节脱位（dislocation of artificial joint）、假体松动（prosthesis looseness）等并发症，仅有4例患者术后出现神经精神症状（谵妄）：同期组3例，分期组1例。两组患者的总手术时间(同期组:117.9±23.8min,分期组:124.1±18.8min)、总失血量[同期组:200(160-310)ml,分期组:180(120-300)ml]、总输血量[同期组:300(0-400)ml；分期组:200(0-300)ml]、术后1年功能恢复评分（Harris评分及OHS评分）方面无统计学意义。在住院费用[同期组：9.46(7.0-11.3)万元；分期组：10.53(8.8-11.0)万元]、住院时间（同期组:12.1±3.2天；分期组：20.1±3.5天）及术后肢长差异（同期组：0.31±0.12cm；分期组：0.52±0.14cm）方面，同期组优于分期组，有统计学意义。结论在患者身体条件允许、围手术期管理得当、医师手术技术成熟的情况下，同期行双侧THA是安全可行的，且在患者住院费用、住院时间、术后肢长差异方面与分期行双侧THA相比，更具一定的优势。
[Abstract]:Therefore, in view of this controversy, this study retrospectively analyzed the clinical efficacy and safety of patients with bilateral THA at the same time and staging, and compared the clinical efficacy and safety of the patients with bilateral THA at the same time and stage. To provide a reference for bilateral hip joint lesions can be selected at the same time bilateral THA. Among them, 29 patients in the same period group were treated with bilateral THA at the same time, and 29 patients in the staging group were treated with bilateral THA at the same time. Follow-up and retrospective analysis of two groups of patients. Preoperative and 1 year postoperation Harris score and Oxford Hip scale score were used to evaluate the Oxford Hip ScoreOHS, perioperative complications. Only 4 patients developed neuropsychiatric symptoms after operation (delirium: 3 cases in the same period group and 1 case in the staging group). Conclusion under the condition of patient's physical condition, proper management in perioperative period and mature surgical technique, it is safe and feasible to take bilateral THA simultaneously, and it is safe and feasible in the patient's hospitalization cost and hospitalization time. The difference of limb length after operation was better than that of staging bilateral THA.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.4

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