滑膜切除对全膝关节置换治疗骨性关节炎的影响

目的探讨全膝关节置换术（TKR）治疗骨性关节炎时同时行滑膜切除术对术后失血及临床结果的影响。方法选取符合骨性关节炎诊断标准并拟行单侧TKR的病人374例,随机分为两组,观察组192例,TKR时切除滑膜;对照组182例,TKR时保留滑膜。测定并比较两组术后引流量、输血率,计算隐性失血量;采用疼痛视觉模拟评分（VAS）和膝关节协会临床评分及功能评分（KSS）比较两组治疗效果。结果术前两组病人各项指标差异均无统计学意义（P〉0.05）。术后24h引流量、隐性失血量观察组明显高于对照组,差异有显著性（t=2.137、2.238,P〈0.05）,两组输血率差异无显著性（P〉0.05）。两组术后24h、3d及4周VAS差异无显著性（P〉0.05）。两组术后4周、12个月KSS差异无显著性（P〉0.05）。术后12、24个月时两组KSS、浮髌试验阳性率差异均无显著性（P〉0.05）。结论 TKR治疗骨性关节炎同时切除滑膜会增加术后出血,但对远期临床结果无明显影响。

EFFECT OF SYNOVECTOMY ON TOTAL KNEE REPLACEMENT FOR OSTEOARTHRITIS

Objective To investigate the effect of with or without synoveetomy at total knee replacement （TKR） on postoperative bleeding and clinical outcomes. Methods A total of 374 patients meeting the criteria of osteoarthritis and scheduled for unilateral TKR were randomized to two groups： observation group （n = 192）, synovectomy done at TKR, and control group, TKR without synoveetomy. Postoperatve drainage volume and blood transfusion were compared between the two groups. The hidden blood loss was calculated. Employing VAS and KSS score, the treatment effectiveness between the two groups was compared. Results Preoperatively, there were no statistical differences between the two groups with regard to clinical parame ters. Postoperatively, the drainage volume in 24 hours and hidden blood loss in the observation group were higher than that in the control （t =2.137,2.238;P〈0.05）. The difference of blood transfusion rate was not significant between the two groups （P〉 0.05）. There were no significant differences between the two groups in terms of the following items： the VAS 24 hours, three days and four weeks after surgery （P〉0.05） ; the KSS four weeks and 12 months after surgery （P〉0.05） ; the KSS and positive rate of floating patella test 12 and 24 months after surgery （P〉0.05）. Conclusion Synovectomy to be done at total knee replacement may increase postoperative blood loss, but it does not affect long-term clinical outcomes.