Thienpont Emmanuel, Grosu Irina, Paternostre Frederic, Schwab Pierre-Emmanuel, Yombi Jean Cyr
Department of Orthopedic Surgery, Cliniques Universitaires Saint Luc, Av. Hippocrate 10, 1200, Brussels, Belgium,
Knee Surg Sports Traumatol Arthrosc. 2015 Jul;23(7):2055-60. doi: 10.1007/s00167-014-2952-2. Epub 2014 Mar 27.
Blood loss can be substantial and will influence morbidity and mortality after total knee arthroplasty. This study evaluated whether patient-specific instruments (PSI) can reduce blood loss because the intramedullary canal is not opened during the procedure and whether hidden blood loss can be reduced by its use.
Seventy-five patients operated with the Signature PSI technique were compared with a matched group operated with conventional instruments. Maximal drop in haemoglobin (Hb) and hematocrit (HTC) level were compared at day 2 and day 4. Transfusions were noted. Clinical outcomes like range of motion and knee society scores were studied as secondary outcomes.
No statistically significant difference for calculated blood loss, maximal drop in Hb or HTC and transfusions were found. No clinical differences in range of motion or knee society scores were observed.
The use of PSI-assisted total knee arthroplasty (TKA) did not result in less blood loss compared with conventional minimally invasive TKA with tourniquet. No reduction in hidden blood loss was observed either. According to this study, the argument of reduced transfusion cost should not be used in cost-effectiveness calculations of PSI-assisted TKA.
III.
全膝关节置换术后失血可能较多，会影响发病率和死亡率。本研究评估了定制器械（PSI）是否能减少失血，因为手术过程中未打开髓腔，以及使用PSI是否能减少隐性失血。
将75例采用Signature PSI技术进行手术的患者与一组采用传统器械进行手术的匹配患者进行比较。比较术后第2天和第4天血红蛋白（Hb）和血细胞比容（HTC）水平的最大降幅。记录输血情况。将诸如活动范围和膝关节协会评分等临床结果作为次要结果进行研究。
在计算的失血量、Hb或HTC的最大降幅以及输血方面，未发现统计学上的显著差异。在活动范围或膝关节协会评分方面未观察到临床差异。
与使用止血带的传统微创全膝关节置换术相比，使用PSI辅助全膝关节置换术（TKA）并未减少失血。也未观察到隐性失血的减少。根据本研究，在PSI辅助TKA的成本效益计算中，不应使用减少输血成本这一论据。
III级。
