Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir Cd., Muratpasa, 07100, Antalya, Turkey.
Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
Arch Orthop Trauma Surg. 2023 Jun;143(6):3309-3317. doi: 10.1007/s00402-022-04596-x. Epub 2022 Aug 26.
The purpose of this randomized controlled study was to examine the effect of sealing the intramedullary canal with a bone or cement plug or leaving it empty on postoperative bleeding and pain MATERIALS AND METHODS: A total of 120 patients with knee osteoarthritis who underwent unilateral TKA participated in the trial and were assigned to one of three groups. The femoral canal was sealed with an autogenous bone plug (Group I) or cement plug (Group II), or it was left open (Group III). Estimated blood loss, Hemoglobin decline, bleeding into the drain, and postoperative pain w compared between groups.
Six patients were excluded due to various reasons, and the remaining 114 patients were included in the final analysis. There were no significant variations in baseline clinical characteristics between the three groups (p > 0.05). Hemoglobin reduction between preoperative and 72 h after the surgery (p: 0.034) and estimated blood loss (p: 0.003) were significantly different between groups. The cement plug group showed the least bleeding. Although there was a significant difference between the cement and empty canal groups (p: 0.03 and p: 0.002, respectively), the difference between the cement and bone groups was similar regarding both hemoglobin reduction and estimated blood loss. The blood volume in the suction drain (p: 0.598) and transfusion rate (p: 0.087) were similar between the groups. VAS at the 12 h after the surgery was similarly high in each group (p: 0.676). It declined at 36 h after surgery, but no significant difference was determined between groups (p: 0.815).
This study showed that estimated blood loss and hemoglobin reduction were significantly lower in the cement plug group than in the empty canal group. But bone plug group did not show any difference with both empty canal and cement plug groups. Sealing the IM canal or leaving it open did not change the bleeding into the drain, transfusion rate, and postoperative pain between groups. Based on these findings, sealing the IM canal with a cement plug might be recommended to diminish bleeding during TKA despite similar transfusion rates.
Level I, randomized controlled trial.
本随机对照研究的目的是探讨髓内管内用骨塞或水泥塞或不填充对术后出血和疼痛的影响。
共纳入 120 例单侧 TKA 患者参与试验，并将其分为三组。股骨管内分别用自体骨塞（I 组）或水泥塞（II 组）填充或不填充（III 组）。比较各组间失血量、血红蛋白下降、引流出血及术后疼痛。
由于各种原因，有 6 例患者被排除，最终有 114 例患者纳入最终分析。三组患者的基线临床特征无显著差异（p>0.05）。血红蛋白从术前到术后 72 小时的下降（p：0.034）和估计失血量（p：0.003）在组间存在显著差异。水泥塞组出血最少。尽管水泥和空管组之间存在显著差异（p：0.03 和 p：0.002），但水泥和骨组之间在血红蛋白下降和估计失血量方面相似。引流血量（p：0.598）和输血率（p：0.087）在各组之间相似。术后 12 小时 VAS 评分在每组均较高（p：0.676）。术后 36 小时下降，但组间无显著差异（p：0.815）。
本研究表明，与空管组相比，水泥塞组的估计失血量和血红蛋白下降明显较低。但与空管和水泥塞组相比，骨塞组无明显差异。髓内管内填充或不填充对引流出血、输血率和术后疼痛无影响。基于这些发现，尽管输血率相似，但在 TKA 中使用水泥塞填充髓内管可能有助于减少出血。
I 级，随机对照试验。
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