Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, 610041, China.
Int Orthop. 2019 Sep;43(9):2083-2091. doi: 10.1007/s00264-018-4174-6. Epub 2018 Oct 23.
The purpose of this study was to investigate the benefits of three different post-operative limb positions in primary total knee arthroplasty (TKA).
The trial was a single-surgeon, randomized, controlled trial, and 135 patients following primary TKA were randomized into three groups: group A (45 patients who were treated with the hip fixed at 50° and knee flexed at 90° for 6 hours post-operatively), group B (45 patients who were treated with the hip elevated at 30° and knee flexed at 45° for 6 hours post-operatively), and group C (45 patients in whom the affected knee was fully extended after surgery). Tranexamic acid was used in all patients.
The total blood loss and hidden blood loss in group A (921 ± 209 mL, 597 ± 213 mL) were significantly less than in groups B (1125 ± 222 mL, 784 ± 229 mL) and C (1326 ± 291 mL, 915 ± 301 mL) and less in group B compared with group C. The drain volume in groups A (158 ± 35 mL) and B (174 ± 45 mL) was significantly lower than in group C (249 ± 31 mL). The maximum haemoglobin drop in group A (3.1 ± 0.5 g/dL) was statistically significantly less than in groups B (3.6 ± 0.7 g/dL) and C (4.3 ± 0.4 g/dL). The range of motion (ROM) in groups A (102 ± 3°, 105 ± 2°) and B (100 ± 3°, 104 ± 2°) was significantly better than in group C (98 ± 3°, 102 ± 2°) at the time of discharge and one month after surgery; it was also significantly less for group A (104.9 ± 2.1%, 108.0 ± 2.4%) compared with groups B (106.7 ± 3.1%, 108.3 ± 2.7%) and C (108.4 ± 3.2%, 110.6 ± 3.0%) with post-operative knee swelling. No differences in transfusion requirements and complications were observed among the three groups.
The affected knee flexion position was superior to the use of a fully extended position for blood management, but it only contributed to better early functional recovery up to three months post-operatively in TKA. In addition, by fixing the affected knee at a high flexion position of 90°, patients could achieve less blood loss, lower knee swelling, and better early results for ROM and patient satisfaction than the other two groups.
本研究旨在探讨初次全膝关节置换术后三种不同肢体位置的益处。
本试验为单医生、随机、对照试验，对 135 例初次 TKA 患者进行随机分组：A 组（45 例术后髋关节固定在 50°，膝关节屈曲 90°，持续 6 小时），B 组（45 例术后髋关节抬高 30°，膝关节屈曲 45°，持续 6 小时），C 组（45 例术后患膝关节完全伸直）。所有患者均使用氨甲环酸。
A 组（921±209ml，597±213ml）总失血量和隐性失血量明显少于 B 组（1125±222ml，784±229ml）和 C 组（1326±291ml，915±301ml），B 组明显少于 C 组。A 组（158±35ml）和 B 组（174±45ml）引流液量明显低于 C 组（249±31ml）。A 组（3.1±0.5g/dL）最大血红蛋白下降量明显低于 B 组（3.6±0.7g/dL）和 C 组（4.3±0.4g/dL）。A 组（102±3°，105±2°）和 B 组（100±3°，104±2°）出院和术后 1 个月的关节活动度（ROM）明显优于 C 组（98±3°，102±2°），A 组（104.9±2.1%，108.0±2.4%）也明显优于 B 组（106.7±3.1%，108.3±2.7%）和 C 组（108.4±3.2%，110.6±3.0%）的膝关节肿胀。三组患者输血需求和并发症无差异。
与完全伸直位相比，患膝屈曲位在血液管理方面具有优势，但仅在初次 TKA 术后 3 个月内有助于更好的早期功能恢复。此外，将患膝固定在 90°的高屈曲位，与其他两组相比，患者可以获得更少的出血量、更低的膝关节肿胀、更好的早期 ROM 和患者满意度。
