Wang Xiaojian, Xu Ting, Wang Rui, Wang Penghe, Jin Shuaijie, Tong Peijian, Lv Shuaijie
The First Clinical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Evid Based Complement Alternat Med. 2021 Aug 20;2021:9990413. doi: 10.1155/2021/9990413. eCollection 2021.
To investigate the efficacy and safety of performing primary unilateral total knee arthroplasty (TKA) in the "Si hour-period" meaning 09:00 a.m. to 11:00 a.m. (one of the 12 two-hour periods into which the day was traditionally divided, each being given the name of one of the 12 earthly branches), compared with the "Wei hour-period" (13:00-15:00).
Patient documentations were studied for those who underwent a primary unilateral TKA performed by the same surgical team with a tourniquet between January 2018 and January 2021 at our medical center. Eighty-four patients were enrolled and assigned into group A (in Si hour-period) and group B (in Wei hour-period). The main outcomes were total blood cell loss (TBL), hidden blood loss (HBL), visible blood loss (VBL), maximum hemoglobin (Hb) drop, and transfusion rate. Secondary outcomes were length of hospital stay (LOS), postoperative femorotibial mechanical axis (FTMA), FTMA correction, platelet count, plasma D-dimer (D-D), prothrombin time (PT), international normalized ratio (INR), and the incidence of postoperative complications.
Group A showed statistical significance lower at the mean TBL, the mean HBL, and the maximum Hb drop (95% : -352.8 to -46.1,=0.011, 95% -348.0 to -40.1,=0.014, and 95% -9.5 to -0.7,=0.023, respectively) after TKA than group B. The postoperative platelet count of group A was more significant than that of group B (95% :3.1 to 52.9, =0.028). The VBL, transfusion rate, the LOS, postoperative FTMA, FTMA correction, plasma D-D, PT, INR, and the incidence of postoperative complications (wound complications, calf muscular vein thrombosis, infection, pulmonary embolism, and deep vein thrombosis) were similar between the two groups ( > 0.05, respectively).
Our study shows that blood loss can be reduced when TKA is performed in the "Si hour-period," which may be due to increasing platelet count, and postoperative complications did not increase, compared with the Wei hour-period. We recommend that the selective operation, such as TKA, should be performed in the "Si hour-period" in clinical practice between the two hour-period.
探讨在“巳时”（即上午9点至11点，传统上一天被划分为12个两小时时段，每个时段以十二地支之一命名）进行初次单侧全膝关节置换术（TKA）的疗效和安全性，并与“未时”（13点至15点）进行比较。
研究了2018年1月至2021年1月在我们医疗中心由同一手术团队使用止血带进行初次单侧TKA的患者病历。84例患者被纳入并分为A组（巳时手术）和B组（未时手术）。主要结局指标为总血细胞丢失量（TBL）、隐性失血（HBL）、显性失血（VBL）、最大血红蛋白（Hb）下降值和输血率。次要结局指标为住院时间（LOS）、术后股胫机械轴（FTMA）、FTMA矫正、血小板计数、血浆D-二聚体（D-D）、凝血酶原时间（PT）、国际标准化比值（INR）以及术后并发症的发生率。
TKA术后，A组的平均TBL、平均HBL和最大Hb下降值均显著低于B组（95%置信区间分别为：-352.8至-46.1，P = 0.011；-348.0至-40.1，P = 0.014；-9.5至-0.7，P = 0.023）。A组术后血小板计数显著高于B组（95%置信区间：3.1至52.9，P = 0.028）。两组之间的VBL、输血率、LOS、术后FTMA、FTMA矫正、血浆D-D、PT、INR以及术后并发症（伤口并发症、小腿肌静脉血栓形成、感染、肺栓塞和深静脉血栓形成）的发生率相似（P均>0.05）。
我们的研究表明，与未时相比，在巳时进行TKA可减少失血，这可能是由于血小板计数增加，且术后并发症并未增加。我们建议在临床实践中，像TKA这样的选择性手术应在这两个时段中的巳时进行。
