The effect of flexion position maintenance time on Hb, ROM and VAS after total knee arthroplasty
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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。 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. -
Key words:
- 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)男性 女性 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 0.374a 1.944b 0.595b 0.801b 0.353b 0.429b 1.910b 1.641b 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。 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±2.78a 3.31±0.85a 48 h组 37 45.02±3.18ab 2.06±0.49ab 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。 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±6.18a 103.29±5.85a 105.73±5.52a 48 h组 37 112.28±7.02ab 109.06±6.19ab 111.54±6.75ab 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。 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±5.18a 71.64±5.52a 75.66±6.04a 48 h组 37 64.58±6.02ab 76.87±7.14ab 80.19±6.26ab 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。 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±0.52a 2.51±0.45a 2.23±0.42a 48 h组 37 2.73±0.48ab 2.04±0.38ab 1.89±0.24ab 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。 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 r值 P值 Hb 0.519 <0.001 ROM 0.491 <0.001 VAS -0.494 <0.001 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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