运动体位下间断缝合在人工全膝关节置换术中的应用研究

Application of interrupted suture at exercise position in total knee arthroplasty

目的探讨人工全膝关节置换术(total knee artroplasty,TKA)中采用运动体位下间断缝合手术切口的疗效。方法选取2015年7月—2016年7月收治的84例拟行TKA的膝关节骨关节炎患者,随机分为对照组及观察组,每组42例。两组患者性别、年龄、侧别、体质量指数、骨关节炎分级等一般资料比较,差异均无统计学意义(P>0.05)。术中对照组于膝关节屈曲位间断缝合切口,观察组于运动体位间断缝合切口;两组术前和术后处理方法一致。比较两组切口长度、缝合时间、曲马多使用量、术中出血量、拆线时间、住院时间、术后并发症发生率、切口愈合评分(HWES)、患者切口自评满意度评分(Liktert评分);手术前后采用疼痛视觉模拟评分(VAS)评价疼痛程度,美国特种外科医院(HSS)评分和关节活动度(range of motion,ROM)评估膝关节功能。结果两组切口长度、术后并发症发生率、HWES评分、拆线时间及住院时间比较,差异无统计学意义(P>0.05);对照组缝合时间、术中出血量和Likter评分明显低于观察组,但术后曲马多使用量明显高于观察组,比较差异均有统计意义(P<0.05)。两组患者均获随访,对照组随访时间为12～24个月,平均14.7个月;观察组为12～23个月,平均15.3个月。两组患者术前及术后第1天睡觉前、拆线时VAS评分比较,差异均无统计学意义(P>0.05);观察组术后第1天屈伸功能锻炼时VAS评分明显低于对照组(P<0.05)。两组术前以及术后12个月时HSS评分、ROM比较,差异无统计学意义(P>0.05);观察组患者出院时以及术后1、3、6个月时以上两指标均优于对照组(P<0.05)。结论与膝关节屈曲位间断缝合相比,TKA术中采用运动体位下间断缝合切口,患者术后疼痛程度轻、切口愈合好、早期可获得较满意关节功能,但两者远期疗效无明显差异。

Objective To investigate the effectiveness of interrupted suture under exercise position in total knee arthroplasty （TKA）. Methods Eighty-four patients with osteoarthritis who were treated with TI（A between July 2015 and July 2016 were enrolled in the study. All patients were randomly divided into control group and observation group with 42 cases in each group. There was no significant difference in gender, age, side, body mass index, and osteoarthritis grading between 2 groups （P〉0.05）. The incisions were interrupted sutured at the knee flexion position in control group and at the exercise position in observation group. Preoperative and postoperative treatments of 2 groups were same. The incision length, suture time, total tramadol usage, intraoperative blood loss, stitches removal time, hospitalization time, incidence of postoperative complication, the incision healing score （HWES）, and satisfaction score of incisional self evaluation （Liktert score） were recorded and compared between 2 groups. The visual analogue scale （VAS） score was used to evaluate the incision pain at pre- and post-operation. The hospital for special surgery （HSS） score and range of motion （ROM） were also used to assess the knee function. Results There was no significant difference in incision length, incidence of postoperative complication, HWES score, stitching time, and hospitalization time between 2 groups （P〉0.05）. The suture time, intraoperative blood loss, and Likter score were significantly lower in control group than those in observation group （P〈0.05）, but the total tramadol usage was significantly higher in control group than that in observation group （P〈0.05）. All patients were followed up. The follow-up time ranged from 12 to 24 months （mean, 14.7 months） in control group and from 12 to 23 months （mean, 15.3 months） in observation group. There was no significant difference in VAS scores between 2 groups before operation, before going to bed at the 1st day, and after suture remova/（P〉0.05）. The VAS score of observation group after flexion and extension exercises at the 1st day was significantly lower than that of control group （P〈0.05）. There was no significant difference in HSS score and ROM between 2 groups before operation and at 12 months after operation （P〉0.05）. The HSS score and ROM in observation group at discharge and at 1, 3, and 6 months after operation were superior to those in control group （P〈0.05）. Conclusion Compared with interrupted suture at flexion knee position, the application of interrupted suture at exercise positon in TKA had the advantages of less postoperative pain and good incision healing, and can get satisfactory early joint function recovery. But significant difference in the long-term effectiveness of the two methods was not found.