单髁置换与全膝关节置换后隐性失血的对比研究

Comparison of occult blood loss after unicompartmental knee arthroplasty and total knee arthroplasty

背景:单髁置换相较于全膝关节置换的术中失血量相比较低,但二者之间的术后隐性失血量差异尚未得到广泛研究。目的:对比单髁置换与全膝关节置换后隐性失血的差异,分析术前贫血患者是否也可以在无输血风险的情况下进行单髁置换手术。方法:选择2014年1月至2016年12月联勤保障部队第904医院收治的膝关节骨性关节炎患者148例,其中58例进行单髁置换手术,90例进行全膝关节置换手术。术前及术后第1,4,21,42天,检测两组血红蛋白水平、红细胞比容,计算隐性失血量与输血率。试验获得联勤保障部队第904医院伦理委员会批准,批准号:2019-01-03。结果与结论:①单髁置换组术后第1,4天的血红蛋白水平高于全膝关节置换组(P<0.01),两组术前及术后21,42天的血红蛋白水平比较差异无显著性意义(P>0.05);②单髁置换组术后第1,4天的红细胞比容高于全膝关节置换组(P<0.01),两组术前及术后21,42天的红细胞比容比较差异无显著性意义(P>0.05);③在术后第1,4天之间,单髁置换组中女性没有隐性失血,男性平均血红蛋白下降量为4 g/L;全膝关节置换组中女性平均血红蛋白下降量为10 g/L,男性为7 g/L,单髁置换组男性与女性的隐性失血量均低于全膝关节置换组的对应性别患者(P<0.05或P<0.01);④单髁置换组的输血率为0%,全膝关节置换组的输血率为4.4%;术前中度贫血的患者(血红蛋白60-89 g/L),单髁置换组3例均无需输血,而全膝关节置换组6例中2例(33%)需输血;⑤结果表明,单髁置换较全膝关节置换在术后隐性失血方面有明显优势。

BACKGROUND:The intraoperative blood loss of unicompartmental knee arthroplasty is lower than that of total knee arthroplasty,but the difference of postoperative occult blood loss between them has not been widely studied.OBJECTIVE:To compare the difference of occult blood loss between unicompartmental knee arthroplasty and total knee arthroplasty,and to analyze whether patients with preoperative anemia can also undergo unicompartmental knee arthroplasty without the risk of blood transfusion.METHODS:148 patients with knee osteoarthritis treated in 904 Hospital of the Joint Service Support Force of Chinese PLA from January 2014 to December 2016 were selected.Among them,58 cases underwent unicompartmental knee arthroplasty and 90 cases underwent total knee arthroplasty.Hemoglobin levels and hematocrit were measured before and 1,4,21 and 42 days after operation,and the occult blood loss and blood transfusion rate were calculated.The trial was approved by the Ethics Committee of 904 Hospital of the Joint Service Support Force of Chinese PLA(approval No.2019-01-03).RESULTS AND CONCLUSION:(1)The hemoglobin level of unicompartmental knee arthroplasty group was higher than that of total knee arthroplasty group at 1 and 4 days after operation(P<0.01).There was no significant difference in hemoglobin level between the two groups before operation and 21,42 days after operation(P>0.05).(2)Hematocrit in the unicompartmental knee arthroplasty group was higher than that in the total knee arthroplasty group at 1 and 4 days after operation(P<0.01).There was no significant difference in hematocrit between the two groups before operation and 21,42 days after operation(P>0.05).(3)From day one to day four after surgery,there was no occult blood loss in the female of unicompartmental knee arthroplasty group,and the average occult blood loss in the male was 4 g/L.The average occult blood loss was 10 g/L in female and 7 g/L in male in total knee arthroplasty group.The occult blood loss in male and female in unicompartmental knee arthroplasty group was lower than that in total knee arthroplasty group(P<0.05 or P<0.01).(4)The blood transfusion rate was 0%in unicompartmental knee arthroplasty group and 4.4%in total knee arthroplasty group.In patients with preoperative moderate anemia(hemoglobin 60-89 g/L),there was no need for blood transfusion in unicompartmental knee arthroplasty group(n=3),but blood transfusion was needed in 2 of 6 patients in total knee arthroplasty group(33%).(5)The results showed that unicompartmental knee arthroplasty had obvious advantages over total knee arthroplasty in postoperative occult blood loss.