León Vicente J, Lengua María A, Calvo Víctor, Lisón Alonso J
Servicio de Cirugía Ortopédica y Traumatología (Unidad de Cirugía de Rodilla), Hospital de la Vega Lorenzo Guirao, Cieza, Murcia, Spain.
, C/La Ermita, número 4, 2ºD, Guadalupe de Maciascoque, 30107, Murcia, Spain.
Eur J Orthop Surg Traumatol. 2017 Feb;27(2):273-277. doi: 10.1007/s00590-016-1893-5. Epub 2016 Dec 20.
Total knee arthroplasty (TKA) is associated with substantial blood loss. Sources of bleeding are the femoral and tibial intramedullary canals, which are violated during implantation using standard instrumentation. Patient-specific instrumentation (PSI) and computer-assisted surgery (CAS) do not require violation of the intramedullary canals. Therefore, we sought to assess the impact of these methods on blood loss and transfusion requirement. A retrospective cohort study was conducted in a series of 107 consecutive primary TKAs. The first group (n = 32) was operated with standard instrumentation, the second group (n = 35) with CAS and the third group (n = 40) with PSI. A tourniquet was used in all cases. Mean (standard deviation) calculated total blood loss was 442 (160), 750 (271) and 700 (401) ml for the PSI, CAS and standard instrumentation groups, respectively (p < 0.001), with no significant differences between CAS and standard instrumentation (p = 0.799). Significant differences were found in terms of transfusion requirements, with 12.5, 42.9 and 21.8% of the patients requiring transfusion (p = 0.010). Post hoc analysis revealed that only the difference between PSI and CAS were statistically significant (p = 0.003). In conclusion, PSI reduces blood loss when compared to both CAS and standard instrumentation TKA performed with the use of a tourniquet.
全膝关节置换术（TKA）常伴有大量失血。出血来源为股骨和胫骨髓内管，在使用标准器械植入过程中会被破坏。个性化器械（PSI）和计算机辅助手术（CAS）不需要破坏髓内管。因此，我们试图评估这些方法对失血和输血需求的影响。我们对连续107例初次全膝关节置换术进行了一项回顾性队列研究。第一组（n = 32）采用标准器械进行手术，第二组（n = 35）采用计算机辅助手术，第三组（n = 40）采用个性化器械。所有病例均使用止血带。PSI组、计算机辅助手术组和标准器械组计算得出的平均（标准差）总失血量分别为442（160）、750（271）和700（401）ml（p < 0.001），计算机辅助手术组和标准器械组之间无显著差异（p = 0.799）。在输血需求方面发现了显著差异，分别有12.5%、42.9%和21.8%的患者需要输血（p = 0.010）。事后分析显示，只有PSI组和计算机辅助手术组之间的差异具有统计学意义（p = 0.003）。总之，与使用止血带的计算机辅助手术和标准器械全膝关节置换术相比，个性化器械可减少失血。
