Tsukada Sachiyuki, Ogawa Hiroyuki, Saito Masayoshi, Nishino Masahiro, Kusakabe Takuya, Hirasawa Naoyuki
Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Mito, Ibaraki, Japan.
Arthroplast Today. 2025 Feb 28;32:101647. doi: 10.1016/j.artd.2025.101647. eCollection 2025 Apr.
There is conflicting evidence about whether avoiding medullary canal reaming of the femur during total knee arthroplasty (TKA) reduces blood loss. This study aimed to test the hypothesis that total blood loss would decrease in TKA without medullary canal reaming.
This propensity score-matched cohort study included 349 patients, of whom 220 underwent TKA using a femoral intramedullary rod, and 129 underwent TKA using a computer-assisted system without a femoral intramedullary alignment system. For the proximal tibia resection, an intramedullary alignment system was not used in any of the patients. These patients were matched using a one-to-one propensity score method. The primary outcome was perioperative blood loss, calculated from patient blood volume and the difference in hemoglobin levels from preoperative to postoperative measurements.
Compared with 118 propensity score-matched patients undergoing TKA with medullary canal reaming of the femur, perioperative blood loss at 1, 3, and 7 days postoperatively was not significantly different in the 118 matched patients undergoing TKA without medullary canal reaming. In addition, no significant differences were observed in the requirement for allogeneic transfusion or the occurrence of deep venous thrombosis.
Postoperative blood loss did not differ between patients who underwent TKA with femoral intramedullary reaming and those without. This study supports the notion that surgeons can use familiar surgical techniques, including conventional intramedullary rods, without the need for specialized instrument, even for patients at high risk of allogeneic transfusion.
关于全膝关节置换术（TKA）期间避免股骨骨髓腔扩髓是否能减少失血，证据存在冲突。本研究旨在验证全膝关节置换术不进行骨髓腔扩髓时总失血量会减少这一假设。
这项倾向评分匹配队列研究纳入了349例患者，其中220例使用股骨髓内杆进行全膝关节置换术，129例使用无股骨髓内对线系统的计算机辅助系统进行全膝关节置换术。对于胫骨近端切除，所有患者均未使用髓内对线系统。这些患者采用一对一倾向评分法进行匹配。主要结局指标为围手术期失血量，根据患者血容量以及术前至术后血红蛋白水平的差异计算得出。
与118例倾向评分匹配的股骨骨髓腔扩髓全膝关节置换术患者相比，118例倾向评分匹配的未进行股骨骨髓腔扩髓全膝关节置换术患者术后1天、3天和7天的围手术期失血量无显著差异。此外，在异体输血需求或深静脉血栓形成的发生率方面也未观察到显著差异。
进行股骨髓内扩髓的全膝关节置换术患者与未进行该操作的患者术后失血量无差异。本研究支持这样一种观点，即外科医生可以使用熟悉的手术技术，包括传统髓内杆，而无需专门器械，即使对于异体输血高风险患者也是如此。
