膝关节屈曲90°连续缝合切口对全膝关节置换术治疗效果的影响  

Influence of 90°Continuous Suture Incision for Knee Flexion on the Therapeutic Effect of Total Knee Arthroplasty

作　　者：范晓东[1] 张敬堂[1] 张宏伟 FAN Xiao-dong;ZHANG Jing-tang;ZHANG Hong-wei(Department of Orthopaedics,Taihe People's Hospital,Fuyang 236600,China)

机构地区：[1]安徽省太和县人民医院骨一科,安徽阜阳236600

出　　处：《骨科》2021年第5期451-455,共5页ORTHOPAEDICS

基　　金：安徽省教学研究一般基金资助项目(2018jyxm0824)。

摘　　要：目的比较膝关节屈曲90°连续缝合切口和膝关节伸直位连续缝合切口在全膝关节置换术(total knee arthroplasty,TKA)中的应用效果。方法选择2017年1月至2019年1月我院收治的122例拟行TKA手术的病人,采用随机数字表法将病人分为两组,对照组(61例)采用膝关节伸直位连续缝合切口,观察组(61例)采用膝关节屈曲90°连续缝合切口。比较两组病人切口长度、缝合时间、手术时间、术后失血量、直腿抬高活动时间、屈膝90°活动时间、拆线时间、住院时间、Hollander切口愈合(Hollander wound evaluation scale,HWES)评分、美国纽约特种外科医院(American hospital for special surgery,HSS)膝关节评分、Rasmussen评分、膝关节活动范围(ROM)、疼痛视觉模拟量表(visual analogue scale,VAS)以及术后并发症差异。结果两组切口长度、缝合时间、手术时间、术后失血量、直腿抬高活动时间、拆线时间、住院时间、HWES评分、并发症发生率比较,差异均无统计学意义(P均>0.05)。观察组屈膝90°活动时间短于对照组,术后24 h、48 h的HSS评分、Rasmussen评分高于对照组,膝关节ROM大于对照组,术后24 h、48 h、72 h的VAS评分均低于对照组,差异均有统计学意义(P均<0.05)。结论膝关节屈曲90°连续缝合切口可减轻术后早期疼痛程度,利于膝关节功能恢复,且不增加并发症发生风险。Objective To compare the effect of knee flexion 90°continuous suture incision vs.knee extension continuous suture incision in total knee arthroplasty(TKA).Methods A total of 122 patients who planned to undergo TKA surgery in our hospital from January 2017 to January 2019 were selected.The patients were divided into two groups by random number table method.The control group(61 cases)received knee joint continuous suture incision at extension position,and the observation group(61 cases)received knee joint continuous suture incision at 90°flexion.Postoperative follow⁃up was maintained to compare the difference between the two groups in incision length,suture time,operation time,postoperative blood loss,straight leg elevation activity time,knee flexion 90°activity time,suture removal time,hospital stay,Hollander wound evaluation scale(HWES)score,American hospital for special surgery(HSS)score and Rasmussen score,knee range of motion(ROM),visual analogue scale(VAS)score and postoperative complications.Results There were no significant differences in incision length,suture time,operation time postoperative blood loss,straight leg elevation activity time,suture removal time,hospital stay,HWES score and complication rate between the two groups(P>0.05).The time of knee flexion 90°in observation group was significantly shorter than that in the control group(P<0.05).The HSS score and Rasmussen score and the knee ROM at 24 and 48 h after surgery were significantly increased,and the VAS score at 24,48 and 72 h after surgery was significantly decreased in the observation group as compared with those in the control group(all P<0.05).Conclusion The knee flexion 90°continuous suture incision can reduce the degree of early postoperative pain,facilitate the recovery of knee function,and do not increase the risk of complications.

关 键 词：伤口缝合 全膝关节置换术 膝关节功能 疼痛 随机对照研究 

分 类 号：R687.4[医药卫生—骨科学]