摘要
目的 探讨快速康复外科(FTS)理念下全膝关节置换术(TKA)术后屈曲膝关节4 h对减少术后出血的影响。方法 选取2018年1月至2019年12月于南部战区总医院接受TKA的60例(60膝)膝关节骨性关节炎患者作为研究对象。采用系统随机法随机分为观察组和对照组,每组30例(30膝),围手术期均采取FTS管理方案。TKA术后对照组患者采取常规伸直位放置膝关节,观察组采取常规屈曲位(90°)放置膝关节4 h后改为伸直位。观察两组患者术后1 d引流量、血红蛋白和红细胞压积值,以及术前和术后3 d术侧下肢肿胀程度(髌上10 cm大腿周长),记录术前、术后1个月美国特种外科医院(HSS)评分和并发症发生情况。结果 观察组和对照组术后1 d引流量分别为(90.6±18.5)、(183.6±25.8)mL,观察组引流量低于对照组(P <0.05);对照组和观察组血红蛋白浓度、红细胞压积值分别为(104.6±15.6)和(126.2±9.6)g/L、(31.5±4.5)%和(35.7±3.5)%,两组比较,差异有统计学意义(P <0.05)。术后3 d膝关节肿胀程度观察组较对照组为轻(P <0.05),两组术后1个月HSS评分相近(P>0.05),无一例发生深静脉血栓并发症。结论 FTS理念下采取TKA术后屈曲放置膝关节4 h的肢体管理方案,可在不影响膝关节功能情况下减少手术后出血,减轻肢体肿胀程度,有助于术后加速康复。
Objective To explore the effect of flexing the knee for 4 h under the concept of fast track surgery(FTS) after total knee arthroplasty(TKA) on reducing postoperative bleeding.Methods From January2018 to December 2019,60 patients(60 knees) who received TKA due to knee osteoarthritis in General Hospital of Southern Theater Command were selected as research objects,and randomly divided into an observation group and a control group(each of 30 patients/knees) by systematic random sampling,with perioperative FST management in both groups.In the control group,the knee joints of the patients were placed in the conventional extension position after TKA,while in the observation group,the knee joints were placed in the conventional flexion position(90 degrees) after TKA for 4 h,and then changed to the extension position.Wound drainage volume,hemoglobin and hematocrit values within 1 d after operation,as well as the swelling of the lower limb(the thigh circumference of 10 cm above the patella) on the operation side at preoperation and 3 d after the operation were observed,and the scores of American Hospital of Speical Surgery(HSS) at preoperation and one month after operation and complications were recorded in two groups.Results On the first day after operation,the drainage volume was(183.6 ± 25.8) m L in the control group and(90.6 ± 18.5) mL in the observation group,there was statistical difference between the two groups(P <0.05);the postoperative hemoglobin and hematocrit values were(104.6 ± 15.6) g/L,(31.5 ± 4.5)% in control group and(126.2 ± 9.6) g/L,(35.7 ± 3.5)% in observation group,respectively,with statistical differences between two groups(P <0.05).At 3 d postoperatively,knee joint swelling in observation group was less than that in control group(P <0.05).At one month after the surgery,HSS scores in two groups were similar(P >0.05),and no deep vein thrombosis had happened in either group.Conclusion Limb management program of the flexion of knee joint within 4 h after TKA under the FTS concept could reduce the
作者
陈加荣
沈洪园
李凭跃
CHEN Jiarong;SHEN Hongyuan;LI Pingyue(Department of Orthopedics,General Hospital of Southern Theater Command of PLA,Guangzhou,Guangdong 510010,China)
出处
《中国骨科临床与基础研究杂志》
2024年第3期172-176,共5页
Chinese Journal of Orthopaedic Clinical and Basic Research
基金
广州市科技计划项目(2024A03J0634)。
关键词
骨关节炎
膝
关节成形术
置换
膝
手术后期间
膝关节
运动活动
体位
手术后出血
加速康复外科
Osteoarthritis,knee
Arthroplasty,replacement,knee
Postoperative period
Knee joint
Motor activity
Body position
Postoperative hemorrhage
Fast track surgery
