Jiang Chao, Lou Jieqiong, Qian Wenwei, Ye Canhua, Zhu Shibai
Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 100730, Beijing, China.
School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
Arch Orthop Trauma Surg. 2017 Feb;137(2):257-265. doi: 10.1007/s00402-016-2613-7. Epub 2016 Dec 27.
Controversy still exists regarding positioning of the knee in flexion or in extension after total knee arthroplasty (TKA) impacts treatment outcomes. In this meta-analysis, we evaluated if a postoperative knee position regime could positively affect the rehabilitation.
A comprehensive search for randomized controlled trials (RCTs) assessing the effect of knee positioning after TKA was conducted. The outcomes of interest were blood loss and range of motion (ROM); total calculated blood loss (CBL), drainage volume, hidden blood loss (HBL), decline of hemoglobin level and requirement for blood transfusion.
Ten RCTs involving 962 knees were eligible for meta-analysis. Positioning the knee in flexion after TKA was significantly associated with lesser CBL (P < 0.00001), less HBL (P < 0.00001) and decreased requirement for blood transfusion (P = 0.06). On subgroup analyses, the flexion group was found to have significantly less decrease in hemoglobin level 48 h to 6 days after surgery (P = 0.003), while no significant difference was noted at 24 h after surgery (P = 0.29). Further,a superior ROM was observed in flexion group (5-7 days after surgery) (P = 0.002), while there was no significant difference at 6 weeks. No significant inter-group difference in wound drainage was observed at 24 h after surgery.
Positioning the knee in flexion in the early postoperative stage was associated with significantly lesser CBL, lesser HBL, decreased requirement for blood transfusion and better ROM at least in the early postoperative period, which may contribute to early rehabilitation. However, no significant difference was found in ROM at 6 weeks.
全膝关节置换术（TKA）后膝关节应处于屈曲位还是伸直位仍存在争议，这会影响治疗效果。在这项荟萃分析中，我们评估了术后膝关节位置方案是否能对康复产生积极影响。
对评估TKA后膝关节位置影响的随机对照试验（RCT）进行了全面检索。感兴趣的结果包括失血量和活动范围（ROM）；总计算失血量（CBL）、引流量、隐性失血量（HBL）、血红蛋白水平下降以及输血需求。
10项涉及962个膝关节的RCT符合荟萃分析的条件。TKA后将膝关节置于屈曲位与较少的CBL（P < 0.00001）、较少的HBL（P < 0.00001）以及输血需求降低（P = 0.06）显著相关。在亚组分析中，发现屈曲组在术后48小时至6天血红蛋白水平下降明显较少（P = 0.003），而术后24小时无显著差异（P = 0.29）。此外，在屈曲组观察到更好的ROM（术后5 - 7天）（P = 0.002），而在6周时无显著差异。术后24小时伤口引流组间无显著差异。
术后早期将膝关节置于屈曲位与显著较少的CBL、较少的HBL、输血需求降低以及至少在术后早期更好的ROM相关，这可能有助于早期康复。然而，6周时ROM无显著差异。
