全膝关节置换术后屈曲体位维持时间对Hb和ROM、VAS指标的影响

翁惠英; 沈丹丹; 沈佳敏; 丁丽英

doi:10.16766/j.cnki.issn.1674-4152.003567

全膝关节置换术后屈曲体位维持时间对Hb和ROM、VAS指标的影响

doi: 10.16766/j.cnki.issn.1674-4152.003567

湖州市第一人民医院骨六科，浙江湖州 313000

基金项目:

浙江省医药卫生科技计划项目 2023KY1179

详细信息

通讯作者:
丁丽英，E-mail：178345037@qq.com

中图分类号: R684.3 R687.4
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出版历程
- 收稿日期: 2024-03-06
- 网络出版日期: 2024-07-22

The effect of flexion position maintenance time on Hb, ROM and VAS after total knee arthroplasty

Sixth Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou, Zhejiang 313000, China

摘要

摘要: 目的探讨全膝关节置换术(TKA)患者术后屈曲体位维持时间对Hb和ROM、VAS的影响，并分析体位维持时间对患者术后并发症的影响。方法选择2023年3—11月湖州市第一人民医院收治的110例TKA患者作为研究对象。TKA患者术后均行屈曲体位管理，根据体位维持时间分组，分为6 h组、24 h组、48 h组。比较3组术后7 d时肿胀程度、皮下瘀斑面积；比较3组术后失血量；比较3组术后膝关节活动度及疼痛水平。结果 48 h组术后3 d、5 d Hb水平高于6 h组、24 h组(P＜0.05)；48 h组5 d、7 d ROM高于6 h组、24 h组，VAS评分低于6 h组、24 h组(P＜0.05)；双变量相关性Tau-b(K)分析结果显示，屈曲体位维持时间与Hb、ROM呈正相关关系(r=0.519、0.491，P＜0.001)，屈曲体位维持时间与VAS呈负相关关系(r=-0.494，P＜0.001)；3组并发症发生率[48 h组：5.41%(2/37)；24 h组：8.11%(3/37)；6 h组：13.89%(5/36)]比较，差异无统计学意义(P＞0.05)。结论屈曲体位维持48 h可促进TKA患者术后膝关节功能恢复，降低失血量，缓解术后疼痛，同时体位维持时间还与Hb、ROM及VAS呈正相关关系。
- 膝关节炎 /
- 全膝关节置换术 /
- 屈曲体位 /
- 体位维持时间
Abstract: Objective To investigate the effect of postoperative flexion position maintenance time on Hb, Range of motion (ROM) and visual analogue scale (VAS) in patients undergoing total knee arthroplasty (TKA), and to analyze the effect of position maintenance time on postoperative complications. Methods A total of 110 TKA patients admitted to the First People's Hospital of Huzhou from March to November 2023 were selected as the study subjects. TKA patients were divided into 6 h group, 24 h group and 48 h group according to the time of postural maintenance. The swelling degree and subcutaneous ecchymosis area of the three groups were compared at 7 days after operation. The postoperative blood loss was compared among the three groups. The postoperative knee joint activity and pain level were compared among the three groups. Results The level of Hb in 48 h group was higher than that in 6 h group and 24 h group at 3 d and 5 d after operation (P < 0.05). The ROM of 5 d and 7 d in 48 h group were higher than those in 6 h group and 24 h group, and the VAS scores were lower than those in 6 h group and 24 h group (P < 0.05). Bivariate correlation Tau-b (K) analysis showed that the duration of flexion position was positively correlated with Hb and ROM (r=0.519, 0.491, P < 0.001), and the duration of flexion position was negatively correlated with VAS (r=-0.494, P < 0.001). There was no significant difference in the incidence of complications among the three groups [48 h group: 5.41%(2/37); 24 h group: 8.11%(3/37); 6 h group: 13.89%(5/36), P>0.05]. Conclusion Forty-eight hours of flexion position maintenance can promote the recovery of knee joint function, reduce blood loss and relieve postoperative pain in TKA patients. At the same time, the position maintenance time is positively correlated with Hb, ROM and VAS.
- Knee arthritis /
- Total knee arthroplasty /
- Flexion position /
- Posture maintenance time

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表 1 3组全膝关节置换术患者一般资料比较

Table 1. Comparison of general data of patients undergoing total knee arthroplasty in three groups

组别	例数	性别(例)		年龄 (x±s，岁)	BMI (x±s)	肿胀程度 (x±s，cm)	术前Hb (x±s，g/L)	术前ROM (x±s，°)	术前VAS评分 (x±s，分)	手术时间 (x±s，min)
组别	例数	男性	女性	年龄 (x±s，岁)	BMI (x±s)	肿胀程度 (x±s，cm)	术前Hb (x±s，g/L)	术前ROM (x±s，°)	术前VAS评分 (x±s，分)	手术时间 (x±s，min)
6 h组	36	19	17	57.95±3.15	24.85±1.36	42.35±3.15	133.52±10.44	96.95±9.36	5.75±1.44	130.22±13.52
24 h组	37	20	17	59.62±4.59	24.66±1.52	43.18±2.78	133.69±6.20	95.03±9.04	5.01±1.78	127.84±10.33
48 h组	37	22	15	58.04±4.35	25.03±1.49	42.67±2.53	135.06±8.74	95.67±8.62	5.38±1.61	132.69±10.48
统计量		0.374^a		1.944^b	0.595^b	0.801^b	0.353^b	0.429^b	1.910^b	1.641^b
P值		0.829		0.148	0.554	0.451	0.704	0.653	0.153	0.199
注：^a为χ²值，^b为F值。

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表 2 3组全膝关节置换术患者术后肿胀程度、皮下瘀斑面积比较(x±s)

Table 2. Comparison of postoperative swelling degree and subcutaneous ecchymosis area in three groups of patients undergoing total knee arthroplasty(x±s)

组别	例数	肿胀程度(cm)	皮下瘀斑面积(%)
6 h组	36	49.01±3.09	3.97±1.08
24 h组	37	47.25±2.78^a	3.31±0.85^a
48 h组	37	45.02±3.18^ab	2.06±0.49^ab
F值		16.008	48.835
P值		＜0.001	＜0.001
注：与6 h组比较，^aP＜0.05；与24 h组比较，^bP＜0.05。

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表 3 3组全膝关节置换术患者术后不同时点Hb水平比较(x±s，mL)

Table 3. Comparison of blood loss at different time points after total knee arthroplasty in three groups(x±s, mL)

组别	例数	术后1 d	术后3 d	术后5 d
6 h组	36	100.06±6.75	98.27±6.48	100.04±5.19
24 h组	37	110.06±6.18^a	103.29±5.85^a	105.73±5.52^a
48 h组	37	112.28±7.02^ab	109.06±6.19^ab	111.54±6.75^ab
F值		38.980	27.914	35.089
P值		＜0.001	＜0.001	＜0.001
注：与6 h组比较，^aP＜0.05；与24 h组比较，^bP＜0.05。

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表 4 3组全膝关节置换术患者术后不同时点ROM比较(x±s，°)

Table 4. Comparison of ROM at different time points after total knee arthroplasty in three groups(x±s, °)

组别	例数	术后3 d	术后5 d	术后7 d
6 h组	36	51.29±5.52	62.58±5.48	68.85±5.74
24 h组	37	58.76±5.18^a	71.64±5.52^a	75.66±6.04^a
48 h组	37	64.58±6.02^ab	76.87±7.14^ab	80.19±6.26^ab
F值		51.880	51.134	32.759
P值		＜0.001	＜0.001	＜0.001
注：与6 h组比较，^aP＜0.05；与24 h组比较，^bP＜0.05。

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表 5 3组全膝关节置换术患者术后不同时点VAS比较(x±s，分)

Table 5. Comparison of VAS at different time points after total knee arthroplasty in three groups(x±s, points)

组别	例数	术后3 d	术后5 d	术后7 d
6 h组	36	3.62±0.44	2.88±0.41	2.49±0.36
24 h组	37	3.04±0.52^a	2.51±0.45^a	2.23±0.42^a
48 h组	37	2.73±0.48^ab	2.04±0.38^ab	1.89±0.24^ab
F值		32.053	37.714	27.314
P值		＜0.001	＜0.001	＜0.001
注：与6 h组比较，^aP＜0.05；与24 h组比较，^bP＜0.05。

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表 6 全膝关节置换术患者屈曲体位维持时间与术后失血、ROM及VAS的关系

Table 6. The relationship between the maintenance time of flexion position and postoperative blood loss, ROM and VAS in patients undergoing total knee arthroplasty

指标	屈曲体位维持时间
指标	r值	P值
Hb	0.519	＜0.001
ROM	0.491	＜0.001
VAS	-0.494	＜0.001

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表 7 3组全膝关节置换术患者并发症发生率比较[例(%)]

Table 7. Comparison of the incidence of complications in patients undergoing total knee arthroplasty in the three groups[cases (%)]

组别	例数	皮肤瘀斑	伤口感染	深静脉血栓	合计
6 h组	36	2(5.56)	2(5.56)	1(2.78)	5(13.89)
24 h组	37	1(2.70)	2(5.41)	0	3(8.11)
48 h组	37	1(2.70)	1(2.70)	0	2(5.41)
注：3组并发症发生率比较，χ²=1.623，P=0.444。

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