减少人工膝关节置换失血：两种方法的比较

Comparison of two methods for reducing blood loss during total knee arthroplasty

背景:减少手术失血在一定程度上可以预防人工膝关节置换的并发症,可以减轻术后患肢肿胀和不适,有利于患者术后康复。目的:探讨减少人工膝关节置换失血的方法。方法:将单侧初次人工膝关节置换的患者分为2组。对照组(27例)采用传统的手术方法,全程使用止血带,并留置引流管;实验组(36例)对手术方法进行改良,只有在安装假体时使用止血带,对软组织出血予以充分止血,缝合关节囊后在关节腔内注射止血药液,置换后不留置引流管。比较2组患者的术前、置换后血红蛋白、置换后血红蛋白的下降值、膝关节疼痛评分、关节活动度、输血率、伤口愈合情况等临床结果。结果与结论:(1)两组患者关节置换前血红蛋白差异无显著性意义,置换后第1,4,7天对照组血红蛋白均显著低于实验组,而且对照组血红蛋白跟置换前相比的下降值均显著高于实验组;(2)两组的膝关节疼痛评分差异无显著性意义;(3)置换后第7天实验组膝关节活动度显著大于对照组。(4)对照组置换后输血率为18.5%,1例患者伤口愈合不良;实验组置换后没有患者需要输血,所有患者伤口均正常愈合。(5)两组患者均未出现置换后感染、血肿形成等并发症。(6)结果说明,通过改良手术方法,可以减少人工膝关节置换术的失血量,避免膝关节置换后输血,有助于置换后康复。

BACKGROUND： Reducing blood loss could help to prevent the complications of total knee arthroplasty, relieve the swelling and discomfort postoperatively and acelerate the rehabilitation.OBJECTIVE： To explore the methods for reducing blood loss during total knee arthroplasty.METHODS： Totally 63 patients undergoing primary unilateral total knee arthroplasty were divided into two groups. Group 1 included 27 patients who received the conventional surgical techniques using tourniquet during the whole procedure with wound drainage, as control group. Group 2 included 36 patients who received the modified procedure only using tourniquet during prosthesis implantation without wound drainage, as experimental group. In the experimental group, we stitched the capsule closely. The preoperative and postoperative hemoglobin, decrease of hemoglobin, knee pain score, range of motion blood transfusion rate and wound healing were compared between the two groups.RESULTS AND CONCLUSION： （1） There was no significant difference in preoperative hemoglobin between the two groups. At 1, 4 and 7 days postoperatively, the hemoglobins were significantly lower in the control group than in the experimental group, and the decreases of hemoglobins were significantly lower in the control group than in the experimental group. （2） Knee pain score was not significantly different between the two groups. （3） The range of motion of the knee was significantly larger in the experimental group than in the control group at 7 days. （4） Blood transfusion rate was 18.5% in the control group, and wound healing was poor in one patient. There was no transfused case and wound problem in the experimental group. All wounds were healed normally. （5） There was no infection or hematoma in two groups. （6） With the modified procedure, we could reduce blood loss during total knee arthroplasty without blood transfusion after surgery, which was helpful to postoperative rehabilitation.