全膝关节置换是否封堵股骨髓内定位孔比较△

Total knee arthroplasty with or without plugging femoral intramedullary positioning hole

摘要:

[目的]探究全膝关节置换术（total knee arthroplasty, TKA）中股骨髓内定位孔封堵对围术期失血量的影响。[方法] 2019 年 10 月—2021 年 10 月就诊于本院拟行初次单侧 TKA 的 60 例患者纳入本研究，随机将患者分为两组。其中，30 例术中使用骨塞将股骨髓内定位孔进行封堵，另外 30 例未将定位孔进行封堵，其余两组操作皆相同。比较两组早期临床及检验结果。[结果] 两组手术时间、切口长度、术后首次下床时间、住院时间差异均无统计学意义 （P＞0.05）。封堵组在术中出血量 [(278.7±41.3) ml vs ( 319.7±50.9) ml , P＜0.001]、总失血量 [(1 155.7±260.4) ml vs ( 1 312.0±228.3) ml , P=0.016] 均显著少于开放组。平均随访时间（10.6±2.4）个月，术前两组间 VAS、HSS 评分差异均无统计学意义（P＞0.05），封堵组术后 1 d [(6.7±0.4) vs (7.1±0.5), P=0.010]、7 d 的 VAS 评分 [(5.4±0.6) vs (6.3±0.6), P＜0.001]，及术后 1 d 的 HSS 评分 [(53.7±4.9) vs (49.6±3.7), P＜0.001] 均显著优于开放组。术前两组患者的 Hb、Hct、ESR、CRP 差异均无统计学意义 （P＞0.05）。封堵组术后 1 d 的 Hb、Hct 及术后 3~5 d 的 Hct、ESR、CRP 均显著优于开放组（P＜0.05）。[结论]用骨塞封堵股骨髓内定位孔是一种简单且可十分有效地减少初次 TKA 失血的方法。

Abstract:

[Objective] To compare the early outcomes of total knee arthroplasty (TKA) with or without plugging femoral intramedullary positioning hole. [Methods] From October 2019 to October 2021, a total of 60 patients who were undergoing initial unilateral TKA were included in this study and randomly divided into two groups. Among them, 30 patients used bone plug to seal the femoral intramedullary positioning hole, while other 30 patients had not the hole sealed, and the other surgical manipulations were the same in both groups. The early clinical and blood test results of the two groups were compared. [Results] Although there were no significant differences in operation time, incision length, postoperative walking time, and hospital stay between the two groups (P＞0.05), the plugging group proved significantly superior to the non-plugging group in terms of intraoperative blood loss [(278.7±41.3) ml vs (319.7±50.9) ml, P＜0.001] and total blood loss [(1 155.7±260.4) ml vs (1 312.0±228.3) ml, P=0.016]. The mean follow-up time was of (10.6±2.4) months. There was no significant difference in VAS and HSS scores between the two groups before surgery (P＞0.05), however, the plugging group was significantly better than the non-plugging group in terms of VAS score at 1 day [(6.7±0.4) vs (7.1±0.5), P=0.010] and 7 day [(5.4±0.6) vs (6.3±0.6), P＜0.001] postoperatively, and HSS score [(53.7±4.9) vs (49.6±3.7), P＜0.001] 1 day after surgery. With regard to blood test, there were no significant differences in Hb, Hct, ESR and CRP between the two groups before surgery (P＞0.05), the plugging group was significantly superior to the nonplugging groups regarding Hb, Hct and Hct, ESR and CRP 1, 3 and 5 days after surgery (P＜0.05). [Conclusion] Bone plug used to seal the femoral intramedullary positioning hole is simple, but efficient method to reduce blood loss in primary TKA.