Müller-Rath R, Ingenhoven E, Mumme T, Schumacher M, Miltner O
Arthroskopische Chirurgie, Orthopädische Praxisklinik Neuss, OPN, Neuss.
Z Orthop Unfall. 2010 May;148(3):282-7. doi: 10.1055/s-0029-1240784.
Nowadays, complex arthroscopic procedures of the knee joint, such as ACL reconstruction, are routinely carried out on an outpatient basis. The reduced time spent with the patient places high demands on the surgeon with regard to the management of such cases. The aim of this study was to evaluate the current standards of perioperative management following outpatient arthroscopic surgery of the knee in Germany.
A questionnaire consisting of 18 questions was sent to 215 members of the German Association of Outpatient Arthroscopy (BVASK e. V.), dealing with the following topics: antibiotic prophylaxis, DVT prophylaxis, use of a tourniquet and suction drain, physical therapy, physiotherapy, analgesia, anaesthesia and emergency management. More than 51% of the forms were returned and considered suitable for statistical analysis.
A total of 62% of the surgeons reported the use of an antibiotic prophylaxis (i. v. single shot) in every arthroscopic case, while 19% administer antibiotics only occasionally, especially in ACL reconstruction. Postoperative antibiotic treatment was reserved for special situations, such as prior joint infection. Prophylaxis of DVT by means of low molecular weight heparin was carried out in 96% of the cases. 51% prescribed anticoagulant agents for 1 week, 39% for the duration of reduced weight bearing. Half of the surgeons used a tourniquet cuff, 22% exsanguinate the limb prior to cuff inflation. A suction drainage was applied by 36% of the surgeons regularly and by 45% occasionally. The drain is left for one day by 79% of the surgeons, while 11% reported a shortened use of only several hours. With regard to analgesia, 66% of all surgeons apply some kind of local anaesthetic into the knee joint post surgery. Systemic preoperative analgesics or anti-inflammatory agents are given regularly in 56 % of the cases. A total of 92% of the procedures are carried out under general anaesthesia. In 36% of the cases, some kind of additional regional peripheral anaesthesia is used. With regard to postoperative care, cryotherapy is considered standard (97%) and 64% of the surgeons recommend physiotherapy. Nearly all surgeons (97%) offer the patients the opportunity to reach them personally via mobile phone during the first night following arthroscopic surgery.
DVT prophylaxis with LMWH, general anaesthesia, postoperative cryotherapy and personal availability by phone can be considered part of the standard perioperative management following outpatient knee arthroscopy in Germany. However, a wide variety of treatment options can be found regarding topics such as analgesia, antibiotic prophylaxis, tourniquet, knee drainage and physiotherapy.
如今，膝关节的复杂关节镜手术，如前交叉韧带重建术，通常在门诊进行。与患者相处时间的减少，对这类病例的外科医生管理提出了很高要求。本研究的目的是评估德国膝关节门诊关节镜手术后围手术期管理的当前标准。
向德国门诊关节镜协会（BVASK e. V.）的215名成员发送了一份包含18个问题的问卷，涉及以下主题：抗生素预防、深静脉血栓形成（DVT）预防、止血带和吸引引流管的使用、物理治疗、理疗、镇痛、麻醉和急诊管理。超过51%的问卷被返回并被认为适合进行统计分析。
共有62%的外科医生报告在每例关节镜手术中都使用抗生素预防（静脉单次注射），而19%的医生仅偶尔使用抗生素，尤其是在前交叉韧带重建术中。术后抗生素治疗仅用于特殊情况，如既往关节感染。96%的病例采用低分子量肝素预防DVT。51%的医生开抗凝剂1周，39%的医生开至负重减轻期间。一半的外科医生使用止血带袖带，22%的医生在袖带充气前对肢体进行驱血。36% 的外科医生经常使用吸引引流管，45% 的医生偶尔使用。79% 的医生将引流管留置一天，而11% 的医生报告引流管仅使用数小时。关于镇痛，66% 的外科医生在术后将某种局部麻醉剂注入膝关节。56% 的病例术前常规给予全身性镇痛药或抗炎药。92% 的手术在全身麻醉下进行。36% 的病例使用某种额外的区域外周麻醉。关于术后护理，冷冻疗法被视为标准（97%），64% 的外科医生推荐理疗。几乎所有外科医生（97%）都为患者提供在关节镜手术后的第一个晚上通过手机亲自联系他们的机会。
在德国，使用低分子量肝素预防DVT、全身麻醉、术后冷冻疗法以及通过电话保持个人联系可被视为膝关节门诊关节镜手术后围手术期标准管理的一部分。然而，在镇痛、抗生素预防、止血带、膝关节引流和理疗等主题方面，存在多种治疗选择。
