Ausó-Pérez José Ramón, Rodríguez-Blanes Gloria María
Orthopedic Surgery and Traumatology Service, Hospital Marina Baixa, Avda. Alcalde En Jaume Botella Mayor, s/n, 03570, La Vila Joiosa, Alicante, Spain.
Occupational Health Unit, Public Health Center of Alcoy, Alicante, Conselleria of Universal Health and Public Health, Generalitat Valenciana, Valencia, Spain.
Eur J Orthop Surg Traumatol. 2018 Aug;28(6):1151-1156. doi: 10.1007/s00590-018-2160-8. Epub 2018 Mar 9.
Synovial proliferation is a rather frequent intraoperative finding during the surgery of a total knee replacement. The aim of this study is to asses whether the standard procedure of a synovectomy results in changes in blood loss and in the need for transfusion in the immediate postoperative time after the total knee replacement.
A prospective cohort study was performed with 120 patients undergoing total knee replacement (60 with synovectomy and 60 without it). Data on gender, age, and hemoglobin concentration prior to and after surgery were obtained. A bivariate and multivariate logistic regression analysis was performed.
The male gender as a protective factor [RR 0.25 (0.06-1.01)] and the low preoperative hemoglobin as a risk factor [RR 6.22 (2.48-15.58)] were significant in bivariate analysis. However, only the presence of low preoperative hemoglobin was shown to have an independent risk factor for the need for transfusion [RR 8.55 (2.77-26.45)].
The practice of synovectomy showed no difference either in blood loss or in the number of transfusions. The findings of this study indicate that the practice of a synovectomy in a standard total knee replacement does not generate any benefit or prejudice as to the blood factor of the total knee arthroplasty.
滑膜增生是全膝关节置换手术中较为常见的术中发现。本研究的目的是评估滑膜切除术的标准操作是否会导致全膝关节置换术后即刻的失血量变化和输血需求。
对120例行全膝关节置换术的患者进行前瞻性队列研究（60例行滑膜切除术，60例未行滑膜切除术）。获取患者术前和术后的性别、年龄及血红蛋白浓度数据。进行双变量和多变量逻辑回归分析。
双变量分析显示，男性作为保护因素[相对风险（RR）0.25（0.06 - 1.01）]和术前血红蛋白水平低作为风险因素[RR 6.22（2.48 - 15.58）]具有显著性。然而，仅术前血红蛋白水平低被证明是输血需求的独立风险因素[RR 8.55（2.77 - 26.45）]。
滑膜切除术在失血量或输血量方面均无差异。本研究结果表明，在标准全膝关节置换术中进行滑膜切除术对全膝关节置换术的血液因素没有产生任何益处或损害。
