加速康复外科应用下微创膝关节单髁置换术的疗效分析

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摘要目的探讨应用加速康复外科(enhanced recovery after surgery，ERAS)理念对微创膝关节单髁置换术(unicompartmental knee arthroplasty，UKA)治疗膝关节前内侧间室骨关节炎临床疗效的影响。方法收集南京医科大学附属南京医院骨科于2020年6月至2021年6月因单侧膝关节前内侧间室骨关节炎行UKA的50例患者，随机分为观察组(ERAS组)和对照组(非ERAS组)。观察组25例，男性7例，女性18例；年龄49～77岁，平均(65.32±6.77)岁。对照组25例，男9例，女16例；年龄51～80岁，平均(65.56±7.63)岁。分别记录两组患者手术时间、术中出血量、首次步行时间、住院时长、术后24 h血红蛋白下降值；术后1 d、2 d、3 d疼痛视觉模拟评分(visual analogue scale，VAS)。分别于术后1、3、12个月进行门诊随访，复查X线并记录并发症发生情况，评估患者膝关节活动度(range of motion，ROM)、VAS评分、美国特种外科医院(hospital for special surgery，HSS)膝关节评分。结果所有患者均随访至术后12个月。两组手术时间差异无统计学意义(P＞0.05)；观察组术中出血量高于对照组，差异有统计学意义(P＜0.001)；观察组首次步行时间、住院时长、术后24 h血红蛋白下降值均低于对照组，差异有统计学意义(P＜0.001)。两组不同时间点VAS评分、HSS评分、膝关节ROM比较：术前差异无统计学意义(P＞0.05)；术后1 d、2 d、3 d及1个月VAS评分观察组低于对照组，差异有统计学意义(P＜0.05)；术后1个月HSS评分、膝关节ROM观察组高于对照组，差异有统计学意义(P＜0.05)；术后3个月及12个月两组VAS评分、HSS评分、膝关节ROM比较，差异无统计学意义(P＞0.05)。两组组内不同时间点VAS评分、HSS评分、膝关节ROM比较，差异均有统计学意义(P＜0.001)。末次门诊随访两组均未发生并发症。结论研究结果证明ERAS应用下微创UKA可以减少患者术后早期疼痛和围手术期失血量，促进早期下床活动并减少住院时长，促进膝关节早期功能锻炼，提升患者满意度。ERAS方案是优化UKA围术期管理的有效措施。

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	张申麓
	陈彦博
	汪子杰
	陈以恒
	金成哲

关键词 ：加速康复外科, 单髁置换术, 膝骨关节炎, 微创外科

Abstract：

Objective To investigate the effect of enhanced recovery after surgery(ERAS) concept on the clinical efficacy of minimally invasive unicompartmental knee arthroplasty(UKA) in the treatment of anteromedial knee osteoarthritis.Methods A total of 50 patients with single anteromedial knee osteoarthritis who underwent UKA in our department from June 2020 to June 2021 were randomly divided into two groups：The observation group (ERAS group) and the control group.In the observation group，there were 7 males and 18 females.The patients aged from 49 to 77 years old，with an average age of (65.32±6.77)years.In the control group，there were 9 males and 16 females.The patients aged from 51 to 80 years old，with an average age of (65.56±7.63)years.The operation time，intraoperative blood loss，first walking time，length of hospital stay，and decrease value of hemoglobin value 24 hours after operation were recorded.VAS of knee joint were recorded 1 day，2 and 3 days after operation.Outpatient followup was conducted at 1，3 and 12 months after operation，X-ray was rechecked，complications were recorded，and ROM，VAS and HSS of knee joint were evaluated.Results All patients were followed up until 12 months after surgery.There was no significant difference in operation time between the two groups (P＞0.05).The amount of intraoperative bleeding in the observation group was higher than that in the control group and the difference was statistically significant (P＜0.001).The first walking time，length of hospital stay，and the decrease value of hemoglobin 24 hours after operation in the observation group were lower than those in the control group and the difference was statistically significant (P＜0.001).There was no significant difference in VAS，HSS and ROM of knee joint between the two groups before operation (P＞0.05).The VAS in the observation group was lower than that in the control group at 1 day，2 days，3 days and 1 month after operation，and the difference was statistically significant (P＜0.05).One month after operation，HSS and ROM of knee joint in the observation group were higher than those in the control group and the difference was statistically significant (P＜0.05).There was no significant difference in VAS，HSS and ROM of knee joint between the two groups at 3 and 12 months after operation (P＞0.05).The difference in VAS，HSS and ROM of knee joint within the two groups at different time points were statistically significant (P＜0.001).Up to the last outpatient follow-up，no complications occurred in the observation group and the control group.Conclusion The results of the study prove that minimally invasive unicompartmental knee arthroplasty with ERAS can reduce early postoperative pain and perioperative blood loss，promote early out of bed activities and reduce hospital stay，improve early knee functional exercise，and enhance patient satisfaction.ERAS is an effective measure to optimize the perioperative management of UKA.

Key words： enhanced recovery after surgery unicompartmental knee arthroplasty knee osteoarthritis minimally invasive surgery

作者简介: 张申麓(1997－ )，男，研究生在读，南京医科大学附属南京医院骨科，542747063@qq.com

引用本文:

张申麓，陈彦博，汪子杰，陈以恒，金成哲. 加速康复外科应用下微创膝关节单髁置换术的疗效分析[J]. 实用骨科杂志, 2023, 29(10): 881-.
Zhang Shenlu，Chen Yanbo，Wang Zijie，Chen Yiheng，Jin Chengzhe. Effect of Minimally Invasive Unicompartmental Knee Arthroplasty with Application of Enhanced Recovery After Surgery. sygkzz, 2023, 29(10): 881-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I10/881

［1］Katz JN，Arant KR，Loeser RF.Diagnosis and treatment of hip and knee osteoarthritis：A review［J］.JAMA，2021，325(6)：568-578.
［2］Jang S，Lee K，Ju JH.Recent updates of diagnosis，pathophysiology and treatment on osteoarthritis of the knee［J］.Int J Mol Sci，2021，22(5)：2619.
［3］Ahlb-ck S.Osteoarthrosis of the knee.A radiographic investigation［J］.Acta Radiol Diagn (Stockh)，1968(Suppl)：7-72.
［4］冯重阳，姬振伟，吴鹏，等.膝关节单髁置换术的研究进展［J］.实用骨科杂志，2022，28(6)：528-532.
［5］Repicci JA，Eberle RW.Minimally invasive surgical technique for unicondylar knee arthroplasty［J］.J South Orthop Assoc，1999，8(1)：20-27.
［6］Kehlet H.Multimodal approach to control postoperative pathophysiology and rehabilitation［J］.Br J Anaesth，1997，78(5)：606-617.
［7］Pandit H，Jenkins C，Barker K，et al.The Oxford medial unicompartmental knee replacement using a minimally-invasive approach［J］.J Bone Joint Surg(Br)，2006，88(1)：54-60.
［8］Smith I，Kranke P，Murat I，et al.European society of anaesthesiology.Perioperative fasting in adults and children：Guidelines from the european society of anaesthesiology［J］.Eur J Anaesthesiol，2011，28(8)：556-569.
［9］Wainwright TW，Gill M，McDonald DA，et al.Consensus statement for perioperative care in total hip replacement and total knee replacement surgery：Enhanced Recovery After Surgery (ERAS)Society recommendations［J］.Acta Orthop，2020，91(1)：3-19.
［10］Weimann A，Braga M，Carli F，et al.ESPEN guideline：Clinical nutrition in surgery［J］.Clin Nutr，2017，36(3)：623-650.
［11］Awad S，Varadhan KK，Ljungqvist O，et al.A metaanalysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery［J］.Clin Nutr，2013，32(1)：34-44.
［12］Jaeger P，Nielsen ZJ，Henningsen MH，et al.Adductor canal block versus femoral nerve block and quadriceps strength：A randomized，doubleblind，placebocontrolled，crossover study in healthy volunteers［J］.Anesthesiology，2013，118(2)：409-415.
［13］Perlas A，Kirkham KR，Billing R，et al.The impact of analgesic modality on early ambulation following total knee arthroplasty［J］.Reg Anesth Pain Med，2013，38(4)：334-339.
［14］Li JW，Ma YS，Xiao LK.Postoperative pain management in total knee arthroplasty［J］.Orthop Surg，2019，11(5)：755-761.
［15］Kandarian B，Indelli PF，Sinha S，et al.Implementation of the IPACK (infiltration between the popliteal artery and capsule of the knee) block into a multimodal analgesic pathway for total knee replacement［J］.Korean J Anesthesiol，2019，72(3)：238-244.
［16］Sankineani SR，Reddy ARC，Eachempati KK，et al.Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee)with adductor canal block alone after total knee arthroplasty：A prospective control trial on pain and knee function in immediate postoperative period［J］.Eur J Orthop Surg Traumatol，2018，28(7)：1391-1395.
［17］Harsten A，Kehlet H，Toksvig-Larsen S.Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty：A randomized trial［J］.Br J Anaesth，2013，111(3)：391-399.
［18］Memtsoudis SG，Sun X，Chiu YL，et al.Perioperative comparative effectiveness of anesthetic technique in orthopedic patients［J］.Anesthesiology，2013，118(5)：1046-1058.
［19］周宗科，翁习生，曲铁兵，等.中国髋、膝关节置换术加速康复——围术期管理策略专家共识［J］.中华骨与关节外科杂志，2016，9(1)：1-9.
［20］Smith TO，Hing CB.Is a tourniquet beneficial in total knee replacement surgery?A metaanalysis and systematic review［J］.Knee，2010，17(2)：141-147.
［21］Li B，Wen Y，Wu H，et al.The effect of tourniquet use on hidden blood loss in total knee arthroplasty［J］.Int Orthop，2009，33(5)：1263-1268.
［22］Zhang Q，Liu L，Sun W，et al.Are closed suction drains necessary for primary total knee arthroplasty?A systematic review and metaanalysis［J］.Medicine (Baltimore)，2018，97(30)：e11290.
［23］Huang Z，Ma J，Shen B，et al.General anesthesia：To catheterize or not?A prospective randomized controlled study of patients undergoing total knee arthroplasty［J］.J Arthroplasty，2015，30(3)：502-506.
［24］Faour-Martín O，Valverde-García JA，Martín-Ferrero MA，et al.Oxford phase 3 unicondylar knee arthroplasty through a minimally invasive approach：Longterm results［J］.Int Orthop，2013，37(5)：833-838.
［25］蒋振飞，房顺治，陈敏，等.微创与传统入路单髁置换术治疗膝关节单间室骨关节炎的疗效比较［J］.中华骨与关节外科杂志，2022，15(2)：93-98.
［26］王鸿宇，王妍，杨瑞祥，等.微创第三代牛津单髁置换术治疗膝关节内侧间室骨关节病的远期效果随访［J］.中华外科杂志，2022，60(7)：703-708.