Smith Toby O, Davies Leigh, Hing Caroline B
Norfolk and Norwich University Hospital, UK.
Acta Orthop Belg. 2010 Jun;76(3):298-306.
Optimising knee range of motion following total knee arthroplasty (TKA) is important for patient satisfaction, functional outcome and early rehabilitation to promote accelerated discharge. Historically, wound closure following TKA has been performed in extension. It has been suggested that knee position during wound closure may influence range of motion and clinical outcomes following TKA. The purpose of this study was to determine whether TKA wounds should be closed in flexion or extension. An electronic search of MEDLINE, EMBASE, CINAHL and AMED databases was made in addition to a review of unpublished material. All included papers were critically appraised using a modified PEDro (Physiotherapy Evidence Database) critical appraisal tool. Three papers were eligible, assessing 237 TKAs. On analysis, patients with TKA wounds closed in flexion had greater flexion range of motion and required less domiciliary physiotherapy compared to those with wounds closed in full extension. The specific degree of knee flexion used when closing total knee replacement wounds may be an important variable to clinical outcome. However, the present evidence-base is limited in both size and methodological quality.
全膝关节置换术（TKA）后优化膝关节活动范围对于患者满意度、功能结局以及促进加速出院的早期康复至关重要。从历史上看，TKA后的伤口闭合是在伸直位进行的。有人提出，伤口闭合时的膝关节位置可能会影响TKA后的活动范围和临床结局。本研究的目的是确定TKA伤口应在屈曲位还是伸直位闭合。除了查阅未发表的资料外，还对MEDLINE、EMBASE、CINAHL和AMED数据库进行了电子检索。所有纳入的论文都使用改良的PEDro（物理治疗证据数据库）批判性评价工具进行了严格评价。有三篇论文符合条件，评估了237例TKA。经分析，与伤口在完全伸直位闭合的患者相比，伤口在屈曲位闭合的TKA患者具有更大的屈曲活动范围，并且所需的家庭物理治疗更少。全膝关节置换伤口闭合时使用的特定膝关节屈曲程度可能是影响临床结局的一个重要变量。然而，目前的证据基础在规模和方法学质量上都很有限。
