胫骨高位截骨术或膝关节单髁置换术治疗膝关节骨性关节炎围手术期患者隐性失血情况等比较

PERIOPERATIVE HIDDEN BLOOD LOSS IN PATIENTS WITH KNEE OSTEOARTHRITIS UNDERGOING HIGH TIBIAL OSTEOTOMY VERSUS UNICOMPARTMENTAL KNEE ARTHROPLASTY

目的比较胫骨高位截骨术(HTO)或膝关节单髁置换术(UKA)治疗膝关节骨性关节炎围术期患者隐性失血情况,为临床上两种手术方式的选择提供参考。方法回顾性分析2019年1月—2020年8月我院收治的膝关节骨性关节炎患者157例,按照手术方式不同分为HTO组和UKA组。记录患者术前和术后血细胞比容(HCT),应用Gross方程计算两组患者的总失血量,并进一步计算隐性失血量及隐性失血占比,同时记录并比较两组患者术中出血量、术后引流量、手术时间及术后并发症情况,比较两组患者术前及术后3、6、12个月膝关节疼痛视觉模拟评分(VAS)、美国特种外科医院膝关节评分(HSS)、西安大略和麦克马斯特大学骨关节炎指数评分(WOMAC)。结果所有患者均获得随访,随访时间12~18个月。HTO组总失血量、隐性失血量均高于UKA组,差异有统计学意义(t=8.582、9.795,P<0.05)。两组隐性失血占比比较差异无统计学意义(P>0.05)。两组在术前与术后3、6、12个月VAS、HSS、WOMAC等比较差异均无统计学意义(P>0.05);两组均未发生感染、深静脉血栓形成等并发症;HTO组患者术中出血量、术后引流量和手术时间均高于UKA组,差异有统计学意义(t=1.879~4.120,P<0.05)。结论HTO和UKA围术期患者均有较大比例的隐性失血,HTO组患者隐性失血量及总失血量高于UKA组。两种术式早期疗效无明显差异,临床工作中应关注围术期隐性失血情况,根据患者情况综合考虑选择手术方式。

Objective To investigate perioperative hidden blood loss in patients with knee osteoarthritis undergoing high tibial osteotomy(HTO)versus unicompartmental knee arthroplasty(UKA),and to provide a reference for the selection of the two surgical methods in clinical practice.Methods A retrospective analysis was performed for 157 patients with knee osteoarthritis who were admitted to our hospital from January 2019 to August 2020,and according to the surgical procedure,they were divided into HTO group and UKA group.Hematocrit(HCT)was measured and recorded before and after surgery,and the Gross equation was used to calculate total blood loss,hidden blood loss,and the proportion of hidden blood loss.The two groups were compared in terms of intraoperative blood loss,postoperative drainage volume,time of operation,and postoperative complications,as well as Visual Analogue Scale(VAS),Hospital for Special Surgery Knee Score(HSS),and Western Ontario and McMaster Universities Osteoarthritis Index scale(WOMAC)before surgery and at 3,6,and 12 months after surgery.Results The patients were followed up for 12-18 months.The HTO group had significantly greater total blood loss and hidden blood loss than the UKA group(t=8.582,9.795,P<0.05),and there was no significant difference in the proportion of hidden blood loss between the two groups(P>0.05).There were no significant differences in VAS score,HSS score,and WOMAC score between the two groups before surgery and at 3,6,and 12 months after surgery(P>0.05).No complications such as infection and deep venous thrombosis were observed in the two groups.Compared with the UKA group,the HTO group had significantly greater intraoperative blood loss,a significantly higher postoperative drainage volume,and a significantly longer time of operation(t=1.879-4.120,P<0.05).Conclusion There is a high proportion of hidden blood loss in patients undergoing HTO or UKA during the perioperative period,and the patients undergoing HTO have significantly greater hidden blood loss and total blood loss than those undergoing UKA.The two surgical procedures have a similar short-term effect.Hidden blood loss in the postoperative period should be taken seriously in clinical practice,and the surgical procedure should be selected based on the actual situation of the patient.