初次全膝关节置换术后体位对失血和活动度影响的Meta分析

Meta analysis on effect of postoperative position on blood loss and motion after initial total knee arthroplasty

目的探讨初次全膝关节置换术(TKA)后不同体位摆放对术后相关因素的影响。方法以TKA、total knee arthroplasty、膝关节置换术、术后体位、失血量、活动度等为关键词在PubMed、中国期刊全文数据库(CNKI)、Springer、万方数据库中搜索最新的相关研究并按照相关标准排除,仔细阅读并对其分类总结和相关数据进行综合分析。主要分析患者术后总失血量、术后6周活动度及平均住院日等,使用Revman5.3统计软件。结果共纳入7篇文献。术后24 h失血量分析中,尽管屈曲组的失血量相对伸直组少221.83mL,但差异无统计学意义(P=0.06);48h时,屈曲组相对伸直组失血量少162.59mL,差异有统计学意义(P<0.0001)。屈曲组术后6周下肢活动度比伸直组增加3.16°(P=0.0007),屈曲组相对伸直组住院日减少1.67d,差异有统计学意义(P<0.0001)。结论术后下肢屈曲位摆放对于术后失血量及活动度等有影响,维持时间过短或者过长均可能对减少失血量失去效益。

Objective To explore the effects of different postoperative positions on postoperative related factors after initial total knee arthroplasty(TKA).Methods TKA,total knee arthroplasty,postoperation position,blood loss volume and ROM were served as the key words for retrieving the related studies in the Pubmed,CNKI,Springer,Wanfang database,then the exclusion was conducted according to relevant standards.The screened articles were carefully read for conducting the classification summary and comprehensive analysis.The analysis mainly included the total blood loss volume,postoperative 6 weeks ROM,average hospitalization duration and so on.The corresponding forest and funnel plots were obtained by using statistical software Revman5.3.Results Totally 7 articles were included.In the analysis of postoperative 24 h blood loss volume,the blood loss volume in the flexion group was less than that in the extension group by average 221.83 mL,and there was no statistically significant difference(P=0.06).At 48 h blood loss volume in the flexion group was less than that in the extension group by average 162.59 mL,moreover there was a clear difference(P<0.0001).At postoperative 6 weeks,lower extremity ROM in the flexion group was increased by 3.16°compared with the extension group(P=0.0007).The average hospitalization time of the flexion group were decreased by 1.67 d compared with the extension group,and there was statistically significant difference(P<0.0001).Conclusion Postoperative lower limb flexion position has the related effect on postoperative blood loss and ROM,however in the time of postoperative lower limb position,this study shows the maintaining the lower extremity for 48 h after operation has more clear significance and difference,too short or too long can lose the benefits for decreasing blood loss.Therefore,the postoperative optimal position time is suggested to be 48 h.