抬腿驱血和驱血带驱血对全膝关节置换术后早期疗效的影响

Effects of leg elevation and using exsanguination band blood-expelling methods on the short-term effectiveness after total knee arthroplasty

目的对比研究全膝关节置换术(TKA)过程中抬腿驱血和驱血带驱血对术后早期临床效果的影响。方法选择80例行初次TKA的患者,依据驱血方式的不同分为抬腿驱血组和驱血带驱血组各40例,记录2组患者的临床资料,比较2组术前1 d、术后1 d血红蛋白(HGB)、肌酸激酶(CK)、C反应蛋白(CRP)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、D-二聚体(D-Dimer)水平。比较分析2组术前1 d,术后1 d、3 d、7 d及1个月的疼痛视觉模拟评分(VAS),膝关节活动度(ROM),以及术前1 d,术后7 d、1个月、3个月的美国特种外科医院评分(HSS),并记录术后并发症的发生情况。结果 2组患者的基本情况和术前相关指标差异均无统计学意义。术后1 d抬腿驱血组的HGB水平高于驱血带驱血组(P<0.05),CRP、CK、IL-6、TNF-α、D-Dimer水平低于驱血带驱血组(P<0.05)。2组术后VAS评分呈下降趋势,膝关节ROM、HSS评分呈上升趋势,且抬腿驱血组术后1 d、3 d、7 d VAS评分均低于驱血带驱血组,术后1 d、3 d膝关节ROM均高于驱血带驱血组(P<0.05),不同驱血方式对HSS评分的影响差异无统计学意义。驱血带驱血组患者术后下肢肿胀发生率高于抬腿驱血组(P<0.05),2组其他并发症发生率差异无统计学意义(P>0.05)。结论在TKA中,抬腿驱血不仅操作简便,而且对减轻患者术后早期疼痛、肿胀、炎症反应、静脉血栓等并发症具有一定优势,有助于患者快速康复,临床实用价值更高。

Objective To compare and explore the effects of leg elevation of blood-expelling and blood-expelling by the exsanguination band on the early clinical outcomes during total knee arthroplasty(TKA).Methods A total of 80 patients with initial TKA were selected.According to different blood-expelling methods,patients were divided into the leg elevation of blood-expelling group(n=40) and the blood-expelling by the exsanguination band group(n=40).The clinical data were recorded.The levels of hemoglobin(HGB),creatine kinase(CK),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α and D-Dimer 1 d before operation and 1 d after operation were compared between the two groups.The visual analogue scale(VAS) and knee-joint range of motion(ROM) 1 d before operation and 1 d,3 d,7 d and 1 month after operation,and Hospital for Special Surgery Score(HSS) 1 d before operation and 1 d,7 d,1 month and 3 months after operation were compared and analyzed between the two groups.The incidences of postoperative complications were recorded in the two groups.Results There were no significant differences in general data and clinical indexes before operation between the two groups.One day after operation,the level of HGB was higher in the leg elevation of bloodexpelling group than that in the other group(P <0.05).The levels of CRP,CK,IL-6,TNF-α and D-Dimer were lower in the leg elevation of blood-expelling group than those in the blood-expelling by the exsanguination band group(P <0.05).The knee-joint ROM and HSS of the two groups increased with time after operation,while the VAS decreased.The knee-joint ROM was higher in the leg elevation of blood-expelling group than that in the blood-expelling by the exsanguination group on 1 d and 3 d after operation,while the VAS were lower on 1 d,3 d,and 7 d after operation in the leg elevation of bloodexpelling group than the another group(P<0.05).There were no significant differences for HSS between different bloodexpelling methods.The incidence of lower limb swelling after operation was higher in the blood-expelling by the exsanguination band group than that in the leg elevation of blood-expelling group(P<0.05).The occurrence of other complications between the two groups were no significant differences(P <0.05).Conclusion During TKA,leg elevation of blood-expelling method is not only simple to operate,but also has more advantages in reducing early pain,swelling,inflammatory response,vein thrombosis and other complications,which helps patients recover quickly has higher clinical practical value.