Adult Reconstruction (Dr. van der Merwe), Department of Orthopaedics, University of Saskatchewan, and the Department of Orthopaedics (Dr. Mastell), University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
J Am Acad Orthop Surg Glob Res Rev. 2020 Jan 6;4(1). doi: 10.5435/JAAOSGlobal-D-19-00048. eCollection 2020 Jan.
This review article examines updates to the literature during the past 5 years on numerous topics which were felt to have ongoing controversy. These topics include venous thromboprophylaxis, tranexamic acid usage, tourniquet usage, and wound closure techniques.
For each individual topic, a literature search was conducted on several databases with emphasis on studies that were published in the past 5 years. Preference was given to meta-analyses and randomized controlled trials.
Tranexamic acid is a safe and effective treatment modality, and consideration should be given to use multiple doses and combine different modes of administration. Certain treatment modalities (skin sutures, limited or no tourniquet usage) can cause greater patient satisfaction at a cost of longer operating times. Postoperative anticoagulation is still a very controversial topic. There is however some evidence suggesting prolonging anticoagulation to 35 days postoperative.
By analyzing the results of the aforementioned studies, surgeons can implement the most up-to-date evidence-based care when doing total knee arthroplasty surgery. However, many of these selected topics continue to have a component of ongoing controversy with no definitive conclusions developed in recent literature.
目的：本文综述了过去 5 年中多项存在争议的专题文献更新内容。这些专题包括静脉血栓栓塞预防、氨甲环酸的使用、止血带的使用以及伤口闭合技术。
方法：针对每个专题，在多个数据库中进行文献检索，重点关注过去 5 年发表的研究。优先考虑进行荟萃分析和随机对照试验。
结果：氨甲环酸是一种安全有效的治疗方式，应考虑使用多种剂量并结合不同的给药方式。某些治疗方式（皮肤缝合、使用有限或不使用止血带）可增加患者满意度，但手术时间延长。术后抗凝仍然是一个非常有争议的话题。但有证据表明，术后抗凝时间可延长至 35 天。
结论：通过分析上述研究的结果，外科医生可以在进行全膝关节置换手术时采用最新的基于证据的治疗方法。然而，这些选定的专题中有许多仍然存在争议，最近的文献中也没有得出明确的结论。
