全膝关节置换术中滑膜切除对术后功能恢复及失血影响的临床研究

Synovectomy related to bleeding and clinical outcome during total knee arthroplasty in patients with primary osteoarthritis

[目的]探讨初次全膝关节置换术（TKA）中滑膜切除对围手术期失血量及膝关节功能恢复的影响。[方法]回顾分析2012年3月~2013年2月初次接受TKA治疗且符合选择标准的膝骨关节炎患者205例,其中102例患者术中切除滑膜（试验组）,103例患者术中保留滑膜（对照组）。两组患者基本资料差异无统计学意义,具有可比性。记录并比较两组患者术后红细胞压积（hematocrit,Hct）、Hb、隐性失血量、显性失血量及理论总失血量,以及两组手术时间、住院时间、患肢膝上10 cm周径增加率、VAS评分、关节活动度、HSS评分、WOMAC评分等指标。[结果]术后3 d试验组Hb及Hct低于对照组,差异有统计学意义（P﹤0.05）。试验组显性失血量、隐性失血量及理论总失血量均多于对照组,差异均有统计学意义（P﹤0.05）。试验组手术时间长于对照组,差异有统计学意义（P﹤0.05）。术后3 d两组VAS评分比较,差异无统计学意义（P﹥0.05）。术后3 d及7d,试验组患肢肿胀程度较对照组严重,膝上10 cm周径增加率比较差异有统计学意义（P﹤0.05）。术后患者均获随访,两组患者膝关节功能均有明显改善,术后4周及12个月两组患者的HSS评分较术前提高,差异有统计学意义（P﹤0.05）,组间比较差异无统计学意义（P﹥0.05）。术后4周及12个月两组患者的WOMAC评分较术前减低,差异有统计学意义（P﹤0.05）,但组间比较差异无统计学意义（P﹥0.05）。所有患者术后切口均一期愈合,未出现脂肪液化、切口裂开及感染等并发症。两组均没有发生有临床症状的肺栓塞、深静脉血栓形成以及相关并发症。[结论]TKA术中同时行滑膜切除术延长了手术时间及增加了术后出血量,而对患者术后疼痛的缓解和功能的恢复并无明显作用。

[Objective] To investigate the effect of applying synovectomy on the time of the surgery,bleeding,postoperative pain,clinical and function outcome in primary total knee arthroplasty（ TKA）. [Methods] A total of 205 patients（ 205knees） with osteoarthritis underwent primary TKA between March 2012 and February 2013,whose data met the inclusion criteria and were retrospectively analyzed. They were divided into two groups randomly. Group 1 was study group（ TKA with synovectomy）,group2 was control group（ TKA without synovectomy）. The data were compared between 2 groups,including hematocrit（ Hct）,Hb,hidden blood loss,dominant blood loss,theoretical total blood loss,the operation time,hospitalization days,increasing rate of circumference length above 10 cm of the knee,VAS score,ROM,HSS score,and WOMAC score.[Results] The Hb and Hct of the study group was significantly less than the control group（ P ﹤ 0. 05）. The dominant blood loss,the hidden blood loss and theoretical total blood loss of the study group was significantly higher than the control group（ P﹤ 0. 05）. The surgery time of the study group was significantly longer than the control group（ P ﹤ 0. 05）. There was no significant difference in VAS score at 3 days（ P ﹥ 0. 05）. The increasing rate of circumference length above 10 cm of the knee of the study group was significantly higher than the control group（ P﹤ 0. 05）. The patients were all followed up 12 months. There was no significant difference in the HSS score and the WOMAC score between 2 groups at 1 year after operation（ P ﹥ 0. 05）.The prosthesis was in good position,without loosening,subsidence,or osteolysis. [Conclusion] Patients got TKA with synovectomy have a higher bleeding and longer surgery time. On the contrary they do not have any clinical and function advantages.