人工全膝关节置换术后膝关节屈曲位对术后失血及膝关节活动度影响的研究进展  

The influence of knee flexion position on postoperative blood loss and knee range of motion after total knee arthroplasty

作　　者：武立民 吴元刚[1] 斯海波[1,2] 曾羿[1,2] 刘渊[1] 杨鹏[1] 沈彬[1] WU Limin;WU Yuangang;SI Haibo;ZENG Yi;LIU Yuan;YANG Peng;SHEN Bin(Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China;National Clinical Research Center for Geriatrics,West China)

机构地区：[1]四川大学华西医院骨科,成都610041 [2]四川大学华西医院国家老年疾病临床医学研究中心,成都610041

出　　处：《中国修复重建外科杂志》2020年第4期524-528,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81672219、81802210);四川省科技厅重点研发计划项目(2018SZ0223、2018SZ0250);国家老年疾病临床医学研究中心(四川大学华西医院)项目(Z20191008、Z2018B20);国家级大学生创新创业训练计划项目(201910610143)。

摘　　要：目的总结人工全膝关节置换术(total knee arthroplasty,TKA)后保持膝关节屈曲位对术后失血及早期膝关节活动度影响的研究进展。方法查阅近年国内外有关文献,就TKA术后保持膝关节屈曲位减少失血及增加膝关节活动度的作用机制,膝关节屈曲及伸直位、不同屈曲角度及维持时间的疗效差异进行总结。结果TKA术后膝关节保持屈曲位可通过血管成角变化等减少术后失血、提高屈肌肌力,进而增加膝关节活动度。膝关节屈曲角度较大、维持屈曲位时间较长时,可显著改善术后失血和膝关节活动度;但维持时间≥24 h与<24 h相比,不能进一步减少失血并改善膝关节活动度。结论TKA术后保持膝关节屈曲位是减少术后失血,提高早期膝关节活动度的简单、有效方法,但膝关节最佳屈曲角度及维持时间有待进一步探究。Objective To summarize research progress of the effect of knee flexion position on postoperative blood loss and knee range of motion(ROM)after total knee arthroplasty(TKA).Methods The relevant literature at home and abroad was reviewed and summarized from mechanism,research status,progress,and clinical outcome.The differences of clinical results caused by different positions,flexion angles,and keeping time were compared.Results Keeping knee flexion after TKA can reduce postoperative blood loss through the angle change of blood vessels and increase knee early ROM by improving flexion muscle strength.When the flexion angle of the knee is large and the flexion position is keeping for a long time,the postoperative blood loss and the knee ROM can be significantly improved.However,the amount of blood loss and ROM are not further improved in the patients with keeping knee flexion for more than 24 hours compared with less than 24 hours.Conclusion Keeping knee flexion after TKA is a simple and effective method to reduce postoperative blood loss and improve knee ROM.However,the optimal knee flexion angle and time are needed to be further explored.

关 键 词：人工全膝关节置换术 膝关节 屈曲 术后失血 活动度 

分 类 号：R687.4[医药卫生—骨科学]