Wang Yafei, Li Hongxi, Lian Yongyun, Lu Daifeng, Dong Feng, Zhang Zhitao, Liao Yunjian, Liu Huimin
Department of Orthopedics, the Fourth Affiliated Hospital of Harbin Medical University, Harbin Heilongjiang, 150000, P.R.China.
Department of Orthopedics, the Fourth Affiliated Hospital of Harbin Medical University, Harbin Heilongjiang, 150000,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Apr 15;32(4):400-405. doi: 10.7507/1002-1892.201711067.
To investigate the effectiveness of interrupted suture under exercise position in total knee arthroplasty (TKA).
Eighty-four patients with osteoarthritis who were treated with TKA between July 2015 and July 2016 were enrolled in the study. All patients were randomly divided into control group and observation group with 42 cases in each group. There was no significant difference in gender, age, side, body mass index, and osteoarthritis grading between 2 groups ( >0.05). The incisions were interrupted sutured at the knee flexion position in control group and at the exercise position in observation group. Preoperative and postoperative treatments of 2 groups were same. The incision length, suture time, total tramadol usage, intraoperative blood loss, stitches removal time, hospitalization time, incidence of postoperative complication, the incision healing score (HWES), and satisfaction score of incisional self evaluation (Liktert score) were recorded and compared between 2 groups. The visual analogue scale (VAS) score was used to evaluate the incision pain at pre- and post-operation. The hospital for special surgery (HSS) score and range of motion (ROM) were also used to assess the knee function.
There was no significant difference in incision length, incidence of postoperative complication, HWES score, stitching time, and hospitalization time between 2 groups ( >0.05). The suture time, intraoperative blood loss, and Likter score were significantly lower in control group than those in observation group ( <0.05), but the total tramadol usage was significantly higher in control group than that in observation group ( <0.05). All patients were followed up. The follow-up time ranged from 12 to 24 months (mean, 14.7 months) in control group and from 12 to 23 months (mean, 15.3 months) in observation group. There was no significant difference in VAS scores between 2 groups before operation, before going to bed at the 1st day, and after suture removal ( >0.05). The VAS score of observation group after flexion and extension exercises at the 1st day was significantly lower than that of control group ( <0.05). There was no significant difference in HSS score and ROM between 2 groups before operation and at 12 months after operation ( >0.05). The HSS score and ROM in observation group at discharge and at 1, 3, and 6 months after operation were superior to those in control group ( <0.05).
Compared with interrupted suture at flexion knee position, the application of interrupted suture at exercise positon in TKA had the advantages of less postoperative pain and good incision healing, and can get satisfactory early joint function recovery. But significant difference in the long-term effectiveness of the two methods was not found.
探讨运动位间断缝合在全膝关节置换术（TKA）中的有效性。
选取2015年7月至2016年7月行TKA治疗的84例骨关节炎患者纳入研究。所有患者随机分为对照组和观察组，每组42例。两组患者在性别、年龄、患侧、体重指数和骨关节炎分级方面差异无统计学意义（P>0.05）。对照组在膝关节屈曲位间断缝合切口，观察组在运动位间断缝合切口。两组术前及术后处理相同。记录并比较两组患者的切口长度、缝合时间、曲马多总用量、术中出血量、拆线时间、住院时间、术后并发症发生率、切口愈合评分（HWES）及切口自我评估满意度评分（Likert评分）。采用视觉模拟评分法（VAS）评估术前及术后切口疼痛情况。采用特种外科医院（HSS）评分及关节活动度（ROM）评估膝关节功能。
两组患者在切口长度、术后并发症发生率、HWES评分、缝合时间及住院时间方面差异无统计学意义（P>0.05）。对照组的缝合时间、术中出血量及Likert评分显著低于观察组（P<0.05），但对照组曲马多总用量显著高于观察组（P<0.05）。所有患者均获随访。对照组随访时间为12至24个月（平均14.7个月），观察组随访时间为12至23个月（平均15.3个月）。两组患者术前、术后第1天睡前及拆线后VAS评分差异无统计学意义（P>0.05）。观察组术后第1天屈伸锻炼后VAS评分显著低于对照组（P<0.05）。两组患者术前及术后12个月HSS评分及ROM差异无统计学意义（P>0.05）。观察组出院时及术后1、3、6个月的HSS评分及ROM均优于对照组（P<0.05）。
与膝关节屈曲位间断缝合相比，TKA术中运动位间断缝合具有术后疼痛轻、切口愈合好的优点，能获得满意的早期关节功能恢复。但两种方法的长期有效性差异无统计学意义。
