Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku, 783-8505, Japan.
Department of Anesthesiology, Kochi University, Nankoku, Japan.
Knee Surg Sports Traumatol Arthrosc. 2015 Nov;23(11):3317-23. doi: 10.1007/s00167-014-3141-z. Epub 2014 Jun 24.
It has been known for years that deep vein thrombi (DVT) start to develop during total joint arthroplasty. Previously, we reported effective prevention of venous stasis by transcutaneous electrical nerve stimulation (TENS). It is hypothesized that TENS might be a thromboprophylactic tool for the limb undergoing surgery. The purpose of this study is to clarify the clinical efficacy and safety of TENS in patients during total knee arthroplasty (TKA).
Ninety patients undergoing primary TKA were involved and randomly allocated to the TENS or control group. In the TENS group, electrical stimulation of the common fibular nerve, which produced a brisk dorsiflexion of the ankle, was performed for the operated leg during surgery. In the control group, no electrical stimulation was applied. Serum D-dimer and soluble fibrin monomer complex (SFMC) levels were measured before surgery, immediately after surgery, and post-operative day (POD) 1. Ultrasonography was performed on POD 1.
Immediately after surgery, D-dimer and SFMC levels of each group were significantly lower in the TENS group compared with control (p < 0.05). The incidence of DVT was 11 % (five cases) in the TENS group while 31 % (14 cases) in control (p = 0.02). There were no adverse effects related to TENS.
TENS during TKA showed significant effects on preventing DVT. Sustaining muscle pump activation during surgery prevented not only venous stasis, but also hypercoagulability of blood. Intraoperative TENS is a safe and novel strategy against early post-operative thromboembolism, which is difficult to be completed through existing prophylaxis after total joint arthroplasty.
Randomized controlled trial, Level I.
多年来，人们已经知道深静脉血栓（DVT）在全关节置换术中开始形成。此前，我们报告了经皮电神经刺激（TENS）有效预防静脉淤滞。据推测，TENS 可能是手术肢体的血栓预防工具。本研究旨在阐明 TENS 在全膝关节置换术（TKA）患者中的临床疗效和安全性。
共纳入 90 例初次 TKA 患者，随机分为 TENS 组和对照组。在 TENS 组，在手术过程中对腓总神经进行电刺激，使踝关节产生快速背屈。在对照组中，不进行电刺激。在术前、术后即刻和术后第 1 天（POD）测量血清 D-二聚体和可溶性纤维蛋白单体复合物（SFMC）水平。在 POD1 时进行超声检查。
术后即刻，TENS 组的 D-二聚体和 SFMC 水平均明显低于对照组（p < 0.05）。TENS 组 DVT 发生率为 11%（5 例），对照组为 31%（14 例）（p = 0.02）。TENS 无相关不良反应。
TKA 期间 TENS 对预防 DVT 有显著效果。手术过程中维持肌肉泵的激活不仅可以防止静脉淤滞，还可以防止血液的高凝状态。术中 TENS 是一种安全且新颖的策略，可预防全关节置换术后难以通过现有预防措施预防的早期血栓栓塞，
