[1]李志鹏 昝强 张为宝 杨谢安 支力强△.不同屈曲角度连续缝合对全膝关节置换术后早期功能恢复的影响[J].中国中医骨伤科杂志,2021,29(05):33-37.
　LI Zhipeng ZAN Qiang ZHANG Weibao YANG Xiean ZHI Liqiang.Efficacy of Continuous Suture with Different Flexion Angles onEarly Functional Recovery after Total Knee Arthroplasty[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2021,29(05):33-37.
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不同屈曲角度连续缝合对全膝关节置换术后早期功能恢复的影响()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第29卷
期数:
2021年05期
页码:
33-37
栏目:
临床研究
出版日期:
2021-05-15

文章信息/Info

Title:
Efficacy of Continuous Suture with Different Flexion Angles onEarly Functional Recovery after Total Knee Arthroplasty
文章编号:
1005-0205(2021)05-0033-05
作者:
李志鹏1; 2 昝强3 张为宝3 杨谢安4 支力强2△
1陕西中医药大学(陕西 咸阳,712046)2西安市红会医院3陕西中医药大学附属医院4宝鸡市中医医院
Author(s):
LI Zhipeng1; 2 ZAN Qiang3 ZHANG Weibao3 YANG Xiean4 ZHI Liqiang2△
1Shaanxi University of Traditional Chinese Medicine,Xianyang 712046,Shaanxi China; 2Xi’an Honghui Hospital,Xi’an 710054,Shaanxi China; 3Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang 712000,Shaanxi China; 4Baoji Traditional Chinese Medicine Hospital,Baoji 721000,Shaanxi China.
关键词:
全膝关节置换术;  屈曲缝合;  膝关节活动度;  术后功能恢复
Keywords:
total knee arthroplasty;  flexion suture;  range of motion of knee joint;  postoperative functional recovery
分类号:
R684.3
文献标志码:
A
摘要:
目的:比较全膝关节置换术中切口在膝关节不同屈曲角度下连续缝合对术后早期膝关节功能恢复的影响。方法:回顾性分析2019年2月至2019年10月行初次全膝关节置换术(Total Knee Arthroplasty,TKA)的124例膝骨关节炎患者临床及随访资料,按照缝合时屈膝角度将患者分为4组。第1组27例,采用伸直位连续缝合关闭切口; 第2组20例,采用屈曲30°位连续缝合关闭切口; 第3组36例,采用屈曲60°位连续缝合关闭切口; 第4组41例,采用屈曲90°位连续缝合关闭切口。四组患者性别、年龄、体质量指数、骨关节炎分级等一般资料对比,差异均无统计学意义(P>0.05)。比较四组患者切口缝合时间、切口愈合评分( Hollander Wound Evaluating Score,HWES)、切口并发症发生率,并分别于术前、术后1 d、3 d、7 d、1个月时记录膝关节协会评分系统(Knee Society Score,KSS)评分、膝关节主动活动度(Active Range of Motion,AROM)和被动活动度(Passive Range of Motion,PROM)评估膝关节功能,疼痛视觉模拟评分(Visual Analogue Scale,VAS)评估疼痛程度。结果:第2、3、4组的切口缝合时间明显快于伸直组(第1组),差异有统计学意义(P<0.05); 四组患者伤口拆线时间、术后并发症发生率比较,差异无统计学意义(P>0.05); 第2组与第3组在术后3 d、7 d时的VAS评分均优于第1组及第4组,差异均有统计学意义(P<0.05),但四组术后1 d、1个月时的VAS评分对比差异均无统计学意义(P>0.05); 第2组与第3组在术后1、3、7 d时的AROM和PROM均优于第1组及第4组,差异均有统计学意义(P<0.01),但术后1个月时除第3组AROM仍与第1组、第4组差异有统计学意义外(P<0.05),其他几组间AROM及PROM比较差异均无统计学意义(P>0.05); 第2组与第3组之间术后各时间点的AROM和PROM差异均无统计学意义(P>0.05); 四组患者术后各时间点的KSS评分差异均无统计学意义(P>0.05)。结论:适当的屈曲缝合相比伸直缝合可使患者在术后不增加疼痛的同时更快恢复膝关节功能; 在屈曲缝合角度上,更推荐屈曲30°或60°进行缝合,不仅减少伤口缝合时间,还可在术后早期功能恢复方面取得较好的效果。
Abstract:
To compare the efficacy of continuous suture of incision under different flexion angles on the early functional recovery of knee joint after total knee arthroplasty(TKA).Methods:The clinical and follow-up data of 124 patients with knee osteoarthritis who have undergone primary total knee arthroplasty from February 2019 to October 2019 were analyzed retrospectively.The patients were divided into 4 groups according to the angle of knee flexion during suture.In the group 1,27 cases were closed with continuous suture in straight position.20 cases in group 2 with continuous suture at flexion 30°.36 cases in group 3 with continuous suture at 60° flexion,and 41 cases in group 4.Flexion 90° continuous suture was used to close the incision.There was no significant difference in sex,age,body mass index and osteoarthritis grade among the 4 groups(P>0.05).All the patients in the 4 groups were sutured by the same group of doctors during the operation,and the postoperative treatment plan and rehabilitation exercise were the same.The incision suture time,Hollander wound evaluating score(HWES)and the incidence of incision complications among the four groups were compared.Knee society score(KSS),active range of motion(AROM)and passive range of motion(PROM)of knee joint were recorded before operation,1 d,3 d,7 d and 1 month after operation.Visual analogue scale(VAS)was used to evaluate the degree of pain.Results:The time of incision suture in the group 2 to 4 was significantly faster than that in the group 1(P<0.05),but there was no significant difference in the time of wound suture removal and the incidence of postoperative complications among the 4 groups(P>0.05).The VAS scores of group 2 and group 3 were better than those of the group 1,and the group 4 at 3 d and 7 d after operation,and the differences were statistically significant(P<0.05),but there was no significant difference in the VAS scores of the 4 groups at 1 d and 1 month after operation(P>0.05).On the 1st,3rd and 7th day after operation,the AROM and PROM of group 2 and group 3 were better than those of the group 1 and group 4,and the differences were statistically significant(P<0.01).However,there was no significant difference in AROM and PROM among the other groups except that the AROM of group 2 was still significantly different from that of the group 1 and group 4 at 1 month after operation.There was no significant difference in AROM and PROM at each time point between group 2 and group 3,and there was no significant difference in KSS score among the four groups at each time point(P>0.05).Conclusion:Compared with straight suture,proper flexion suture can make patients recover knee joint function more quickly without increasing pain after operation,and flexion 30° or 60° is more recommended in flexion suture angle,which can not only reduces the time of wound suture,but also achieves better results in early postoperative functional recovery.

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备注/Memo

备注/Memo:
基金项目:陕西省重点研发计划项目-社会发展项目(2020SF-090)西安市科技计划项目(2019114913YX004SF037(7))陕西省名中医昝强传承工作室建设项目(2019009)
△通信作者 E-mail:zhiliqiang2011@126.com
更新日期/Last Update: 2021-05-15