膝关节屈曲位缝合切口对全膝关节置换术早期临床效果的影响

The influence of continuous suture in knee flexion position on early clinical effect of total knee arthroplasty

目的探讨膝关节屈曲位缝合切口对全膝关节置换术(TKA)早期临床效果的影响。方法对2016年9月至2017年9月中国人民解放军西部战区总医院骨科行单侧TKA治疗的膝关节骨关节炎患者74例进行前瞻性随机对照研究。采用随机数字表法将患者分为2组试验组37例,TKA术中采用膝关节屈曲90°连续缝合切口;对照组36例(1例患者退出研究)采用膝关节伸直位连续缝合切口。对2组患者手术切口长度、缝合时间、术后失血量、术后疼痛视觉模拟评分(VAS)、主动直腿抬高时间、屈膝90°时间、Hollander切口愈合评分(HWES)、患者切口自评满意度评分(Likert)、住院时间、拆线时间、术后并发症发生率、曲马多用量、美国特种外科医院膝关节评分(HSS)及术后膝关节活动度(ROM)进行比较。采用GraphPad Prism 6软件对数据进行处理。结果2组患者在年龄、性别构成、侧别、体质量指数(BMI)以及术前膝关节ROM和VAS评分差异均无统计学意义(均P>0.05)。两组患者在切口长度、术后失血量、主动直腿抬高时间、HWES评分、Likert评分、住院时间、拆线时间及术后并发症差异均无统计学意义(均P>0.05)。两组患者均未出现切口裂开、切口延期愈合、浅表切口感染和假体感染等严重并发症。试验组患者术后屈膝90°活动时间、曲马多用量、术后48 h内活动痛VAS评分、术后24 h膝关节HSS评分和术后24 h膝关节ROM均优于对照组(均P<0.05),缝合时间长于对照组(P<0.05)。结论与膝关节伸直位连续缝合相比,TKA术中采用膝关节屈曲90°位连续缝合切口,切口愈合好,患者术后早期疼痛减轻,术后曲马多用量减少,利于患者进行早期膝关节功能恢复,且无明显不良反应,值得在临床上推广;但两者远期疗效无显著差异。

Objective To investigate the influence of knee flexural position suture on early clinical effect of total knee arthroplasty(TKA).Methods A prospective randomized controlled study was conducted on 74 patients with knee osteoarthritis treated with unilateral TKA in the Department of Orthopedics,the General Hospital of the Western Theater Command from September 2016 to September 2017.All patients were randomly divided into 2 groups(37 in study group,36 in control group,one patient withdraw from the study)by the random number table.The incision was continuously sutured at the knee flexion position in study group and at the knee extension position in the control group.The incision length,suture time,postoperative blood loss,visual analogue scale(VAS),active straight leg raising time,knee 90°flexion time,the Hollander Wound Evaluation Scale(HWES),satisfaction score of incisional self-evaluation(Likert score),hospitalization time,stitches removal time,incidence of postoperative complication,total tramadol usage,the Hospital for Special Surgery(HSS)score and range of motion(ROM)were also used to evaluate the knee function.Software of GraphPad Prism 6 was used to perform the statistical analyse of the data.Results There was no significant difference in age,gender,side,body mass index(BMI),preoperative ROM and VAS between 2 groups before operation(all P>0.05).Meanwhile,the difference of incision length,postoperative blood loss,active straight leg raising time,HWES score,Likert score,hospitalization time,stitches removal time and incidence of postoperative complication were also with no statistical significance.No serious complications such as incision dehiscence,delayed wound healing,superficial incision infection and prosthesis infection occured in either group.However,the knee 90°flexion time,total tramadol usage,VAS score at 48 h after surgery,HSS score and knee ROM at 24 h after surgery in the study group were significantly better than that in the control group(all P<0.05).But the suture time in the study group was longer than that in the control group(P<0.05).Conclusion Compared with continuous suture in extension knee position,the application of continuously suture at the knee flexion position in TKA has obvious advantages such as good incision healing,less postoperative pain,less total tramadol usage,satisfactory recovery of early joint function and no obvious adverse effect.But no significant difference in the long-term effectiveness is found between the 2 methods.