滑膜切除对同期双侧全膝关节置换术后失血及功能恢复的影响

The Effect of Synovectomy on Postoperative Bleeding and Functional Recovery of Patients Undergoing the Bilateral Total Knee Arthroplasty

目的:探讨同期双侧全膝关节置换术(TKA)时行滑膜切除术对术后失血量及膝关节功能恢复的影响。方法:2014年11月至2017年12月间因患原发性膝骨关节炎在我院行同期双侧全膝关节置换的患者62例,其中32例术中进行滑膜切除(实验组),30例术中不进行滑膜切除(对照组)。对比两组患者手术时间、术中出血量、住院时间、术后第3天血色素较术前降低值、术后隐性出血量、术后输血率以及术后4周、12个月疼痛视觉模拟评分(VAS)和美国膝关节协会评分(KSS)。结果:两组患者均获得12个月随访。两组患者手术时间、术中出血量差异均无统计学意义(P>0.05);实验组术后输血率明显高于对照组(25%vs. 10%),但差异无统计学意义(P>0.05);实验组住院时间、术后第3天血色素较术前血色素降低值、隐性失血量均高于对照组,差异有统计学意义(P<0.05)。两组术后4周及术后12个月VAS评分、KSS评分(包括临床评分、功能评分)均较术前明显改善,差异有统计学意义(P<0.05)。两组间术前、术后4周及术后12个月VAS评分及KSS评分(包括临床评分、功能评分)差异无统计学意义(P>0.05)。结论:在行同期双侧全膝关节置换治疗骨性关节炎时,与保留滑膜相比,滑膜切除在缓解术后疼痛及改善膝关节功能方面未带来明显获益,且增加了隐性失血量及术后输血率。

Objective To explore the effect of synovectomy on the postoperative pain,bleeding and functional outcome after the bilateral total knee arthroplasty(TKA)for the primary knee osteoarthritis(KOA).Methods Sixty-two KOA patients undergoing the bilateral total knee arthroplasty between November 2014 and December 2017 were selected and randomly divided into an experimental group and a control group,each of 32.The experimental group underwent the bilateral TKA with synovectomy,while the control group was given the bilateral TKA without it.The operative time,blood loss during the surgery,length of hospital stay,the gap in the hemochrome(Hb)before the operation and 2 days after it,hidden blood loss and blood transfusion rate were compared between the 2 groups.The Visual Analogue Scale of pain(VAS)and the Knee Society Knee Score(KSS)were used to evaluate both groups 4 weeks and 12 months after the operation.Results Both groups were followed up for 12 months.There were no significant differences in the operative time and blood loss during the surgery between the two groups(P>0.05).The postoperative blood transfusion rate of the experimental group was higher than that of the control group(25%vs.10%),but not significantly.The length of hospital stay,the decrease of Hb between the pre-operation and 2 days after the operation,and the hidden blood loss of the experimental group were significantly higher than the control group(P<0.05).However,no significant differences were found in the average VAS and KSS values between the two groups before the operation,as well as 4 weeks and 12 months after the operation.Conclusion Performing synovectomy for patients undergoing the bilateral TKA cannot relieve the postoperative pain or promote the knee function,but may increase the hidden blood loss and postoperative blood transfusion rate.