摘要
目的初步探索初次全膝关节置换术后不同膝关节体位对术后失血及功能的影响。方法连续纳入100例因膝关节骨关节炎行初次全膝关节置换术的患者,根据术后膝关节体位分为膝关节屈曲组及膝关节伸直组。屈曲组患者术后下肢抬高45°、膝关节屈曲45°,并维持48 h;伸直组维持膝关节伸直位。主要观察指标为围手术期总失血量、隐性失血量及术后6周膝关节活动度,次要观察指标包括引流量、术后血红蛋白水平、膝关节周径、输血率及并发症发生率。结果屈曲组共纳入50例,女性34例,男性16例,平均年龄63.1岁;伸直组50例,女性32例,男性18例,平均年龄62.4岁。屈曲组的总失血量为(821.4±114.3)m L,较膝关节伸直组(1 008.4±102.6)m L明显降低,差异有统计学意义(P<0.001);屈曲组隐性失血量为(637.5±173.3)m L,伸直组为(763.1±103.5)m L,组间差异有统计学意义(P<0.001)。屈曲组术后24 h引流量为(195.2±64.8)m L,较伸直组引流量(258.1±78.3)m L低,差异有统计学意义(P=0.001)。屈曲组术后48 h血红蛋白较伸直组高,屈曲组术后48 h膝关节周径较伸直组小,差异均有统计学意义;术后6周随访时,两组活动度无明显差异。屈曲组有3例患者于术后48 h内输血,伸直组有9例,组间差异无统计学意义(P=0.06);屈曲组平均住院日较伸直组缩短1.6 d,差异有统计学意义(P<0.001);屈曲组有3例发生伤口浅表感染,伸直组有2例发生,均无深静脉血栓发生。结论初次全膝关节置换术后下肢抬高45°、膝关节屈曲45°并维持48 h可明显减少围手术期失血及膝关节肿胀,加快功能康复。
Objective The purpose of this study was to assess the effect of postoperative knee position on blood loss and clinical function during primary total knee arthroplasty（ TKA）. Methods 100 consecutive patients undergoing primary TKA for degenerative osteoarthritis were prospectively included and allocated into two treatment groups： flexion and extension group.In the flexion group,the affected leg was elevated postoperatively by 45°at the hip,with 45° flexion at the knee,while patients in the extension group had the knee extended fully. The primary outcomes included total blood loss,hidden blood loss and range of motion at six weeks; and secondary outcomes were postoperative hemoglobin level,drainage,transfusion requirement,knee circumference,length of hospital stay,and complications. Results There were 50 patients in flexion group,with 34 females and 16 males. The mean age was 63. 1 years. 50 patients（ 32 females and 18 males） were included in extension group,with mean age of 62. 4 years. Total blood loss（ 821. 4 ± 114. 3 m L Vs 1008. 4. 0 ± 102. 6 m L） and hidden blood loss（ 637. 5 ± 173. 3 m L Vs763. 1 ± 103. 5 m L） were lower in flexion group when compared with extension group,and the differences were significant（ P〈0. 001）. The drainage in flexion group was（ 195. 2 ± 64. 8） m L,which was significantly lower than that in extension group（ 258. 1 ± 78. 3,P = 0. 001）. Patients in flexion group gained higher hemoglobin level and less knee circumference,with statistical significance. The range of motion was similar when follow up at 6 weeks postoperatively（ P〉0. 05）. 3 patients in flexion group and 9 in extension group required transfusion. Superficial wound infection occurred in 3 patients in flexion group and 2 in extension group. None of them developed DVT. Conclusion Postoperative extation of the hip by 45° with 45° knee flexion,is an effective and simple method to reduce blood loss and knee swelling following primary TKA.
出处
《实用骨科杂志》
2016年第8期683-685,689,共4页
Journal of Practical Orthopaedics
