全膝关节置换过程中挤压驱血和抬腿驱血与置换后并发症的关系

Relationship of extrusion and elevation of blood-expelling methods during total knee arthroplasty with postoperative complications

背景:目前挤压驱血法广泛应用于全膝关节置换过程中。有研究表明,挤压驱血法有加重术后早期疼痛及增加术后并发症的风险,因此临床上急需一种能替代它的更加安全有效的驱血方法。目的:探讨全膝关节置换过程中使用抬腿驱血法和挤压驱血法对临床效果的影响。方法:将拟行初次单侧全膝关节置换的64例患者随机分为2组,置换过程中对照组采用挤压驱血,试验组采用抬腿驱血。术后比较2组患者的主要观察指标:目测类比评分、膝关节肿胀度、C-反应蛋白、血清肌酸激酶活性及术后并发症等:次要观察指标:止血带使用时间、美国特种外科医院评分、SF-36评分等。结果与结论:①术后第1,7天及第1,3个月,试验组目测类比评分显著低于对照组(P<0.05);②术后2组的C-反应蛋白水平、血清肌酸激酶活性及膝关节肿胀度均有升高,但试验组的升高程度明显低于对照组(P<0.05);③在术后并发症方面,术后对照组在张力水泡及深静脉血栓发生率上高于试验组(P<0.05),且对照组的总并发症发生率显著高于试验组(P<0.05);④2组止血带的使用时间差异无显著性意义(P>0.05):⑤随访第1,3,6个月评估美国特种外科医院评分及SF-36评分,结果显示较术前均有所改善,但组间比较差异无显著性意义(P>0.05);⑥说明全膝关节置换过程中抬腿驱血可减轻术后早期疼痛反应,降低机体的炎症反应及患膝软组织损伤,减少皮肤张力性水泡、血栓栓塞等并发症的发生率,符合快速康复的理念要求。因此在全膝关节置换过程中抬腿驱血是一种比挤压驱血更加安全有效的驱血方法。

BACKGROUND:At present,extrusion is widely used in total knee arthroplasty.Studies have shown that extrusion can aggravate early pain and increase the risk of complications after operation.Therefore,a safer and more effective method it is urgently needed in clinic.OBJECTIVE:To observe the effects of elevation and extrusion of blood-expelling method on clinical outcomes during total knee arthroplasty.METHODS:Sixty-four patients who were scheduled to undergo unilateral total knee arthroplasty for the first time were randomly divided into two groups.During total knee arthroplasty,the control group received extrusion method,while the experimental group received elevation method.The main outcomes of the two groups were compared:visual analogue scale score,knee joint swelling,C-reactive protein,serum creatine kinase activity and postoperative complications;secondary outcomes:tourniquet use time,Hospital for Special Surgery score,and SF-36 score.RESULTS AND CONCLUSION:(1) Visual analogue scale scores in the experimental group were significantly lower than those in the control group on the first day,the seventh day,the first month and the third month after operation(P <0.05).(2) Knee swelling,serum creatine kinase and C-reactive protein increased in both groups after operation,but the increase in experimental group was significantly lower than that in control group(P <0.05).(3) In terms of postoperative complications,the incidences of tension vesicles and deep vein thrombosis in the control group were higher than those in the experimental group(P <0.05).The total complication rate was significantly higher in the control group than in the experimental group(P <0.05).(4) There was no significant difference in tourniquet use time between the two groups(P>0.05).(5) Hospital for Special Surgery score and SF-36 score were assessed at 1,3 and 6 months.The results showed that it was better than before,but there was no significant difference between the two groups(P> 0.05).(6) In conclusion,elevation of blood-expelling method could alleviate early pain response,reduce inflammation reaction and soft tissue injury,and decrease the incidence of skin tension blisters and thromboembolism.It is in line with the concept of rapid recovery.Therefore,during total knee arthroplasty,elevation of blood-expelling method is a safer and more effective method than extrusion.