Pearse E O, Caldwell B F, Lockwood R J, Hollard J
North Sydney Orthopaedic & Sports Medicine Centre, New South Wales, Australia.
J Bone Joint Surg Br. 2007 Mar;89(3):316-22. doi: 10.1302/0301-620X.89B3.18196.
We carried out an audit on the result of achieving early walking in total knee replacement after instituting a new rehabilitation protocol, and assessed its influence on the development of deep-vein thrombosis as determined by Doppler ultrasound scanning on the fifth post-operative day. Early mobilisation was defined as beginning to walk less than 24 hours after knee replacement. Between April 1997 and July 2002, 98 patients underwent a total of 125 total knee replacements. They began walking on the second post-operative day unless there was a medical contraindication. They formed a retrospective control group. A protocol which allowed patients to start walking at less than 24 hours after surgery was instituted in August 2002. Between August 2002 and November 2004, 97 patients underwent a total of 122 total knee replacements. They formed the early mobilisation group, in which data were prospectively gathered. The two groups were of similar age, gender and had similar medical comorbidities. The surgical technique and tourniquet times were similar and the same instrumentation was used in nearly all cases. All the patients received low-molecular-weight heparin thromboprophylaxis and wore compression stockings post-operatively. In the early mobilisation group 90 patients (92.8%) began walking successfully within 24 hours of their operation. The incidence of deep-vein thrombosis fell from 27.6% in the control group to 1.0% in the early mobilisation group (chi-squared test, p < 0.001). There was a difference in the incidence of risk factors for deep-vein thrombosis between the two groups. However, multiple logistic regression analysis showed that the institution of an early mobilisation protocol resulted in a 30-fold reduction in the risk of post-operative deep-vein thrombosis when we adjusted for other risk factors.
在制定了一项新的康复方案后，我们对全膝关节置换术后早期行走的效果进行了一项审计，并通过术后第五天的多普勒超声扫描评估了其对深静脉血栓形成的影响。早期活动被定义为在膝关节置换术后不到24小时开始行走。在1997年4月至2002年7月期间，98例患者共接受了125次全膝关节置换术。除非有医学上的禁忌证，他们在术后第二天开始行走。他们组成了一个回顾性对照组。2002年8月制定了一项允许患者在术后不到24小时开始行走的方案。在2002年8月至2004年11月期间，97例患者共接受了122次全膝关节置换术。他们组成了早期活动组，前瞻性地收集了该组的数据。两组患者年龄、性别相似，合并症情况相似。手术技术和止血带使用时间相似，几乎所有病例都使用相同的器械。所有患者均接受低分子量肝素预防血栓形成，并在术后穿着弹力袜。在早期活动组中，90例患者（92.8%）在术后24小时内成功开始行走。深静脉血栓形成的发生率从对照组的27.6%降至早期活动组的1.0%（卡方检验，p<0.001）。两组之间深静脉血栓形成危险因素的发生率存在差异。然而，多因素logistic回归分析显示，在对其他危险因素进行校正后，实施早期活动方案使术后深静脉血栓形成的风险降低了30倍。
