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随后的全关节关节整形手术:我们是否从第一阶段学习?

Christine Jiang Wu¹, Colin Penrose², Sean Patrick Ryan³

¹Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States. christine.j.wu@duke.edu.

World journal of orthopedics

|April 10, 2024

概括

由于从最初的手术中学习,患者在第二次全关节整形术 (TJA) 中经历了改善的结果. 手术团队发现分阶段全关节整形术 (THA) 更有效,但对于全膝关节整形术 (TKA) 没有观察到这种效率.

科学领域:

整形外科手术整形外科手术
患者研究成果研究结果
医疗保健服务研究医疗服务研究

背景情况:

全关节整形术 (TJA) 的发病率不断上升,需要采取策略,尽量减少手术前并发症和资源使用.
患有多关节退行性疾病的患者通常需要分阶段的双边手术.

研究的目的:

评估患者和医生从初始关节整形手术过程中学习是否会在随后的手术中改善结果.
在分阶段的双边TJA中确定改善结果的具体领域.

主要方法:

对于初级全关节整形手术 (THA) 和全膝关节整形手术 (TKA) 的机构数据库的回顾性查询.
排除单方面和当天双边TJA案件.
通过第一 vs 第二次手术对患者进行分层,收集人口统计数据,并发症和植入物大小.
评估操作时间,停留时间 (LOS),处置,90天的再接收和急诊室 (ED) 访问.

主要成果:

对642名患者 (364名TKA,278名THA) 的分析显示,分阶段手术之间没有显著的人口或并发症差异.
第二次TJA手术显示停留时间 (LOS) 显著缩短 (P < 0.001).
当使用相同的植入物大小时,关节整形手术 (THA) 总手术时间减少 (P = 0.025);再入院或急救诊所访问没有显著差异.
患者在第二次手术后更有可能在家出院,如果他们的情绪发生了变化 (P = 0.033).

结论:

患者在第二次TJA中表现出更好的术后结果,可能是由于信心增加和焦虑减少.
加强手术前患者教育可能会进一步改善结果.
阶段性THA手术对外科小组来说更有效,尽管对TKA没有观察到这种效率.

关键词:

异步的全关节关节整形术.反侧面的整体关节关节整形术.经期操作结果的结果.阶段性全关节关节整形术.随后的全关节关节整形术.

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