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中华关节外科杂志(电子版) ›› 2025, Vol. 19 ›› Issue (02) : 236 -242. doi: 10.3877/ cma.j.issn.1674-134X.2025.02.014

综述

全膝关节置换术后早期下床影响因素的研究进展
陈俊杰1, 屈明2, 朱锦宇3,()   
  1. 1. 310053 杭州,浙江中医药大学
    2. 711700 渭南,陕西省富平县医院骨科
    3. 314001 嘉兴大学附属医院/嘉兴市第一医院骨科
  • 收稿日期:2024-10-14 出版日期:2025-04-01
  • 通信作者: 朱锦宇
  • 基金资助:
    嘉兴市第一医院/嘉兴学院附属医院联合科研基金(2022LHJJ004)

Research progress on influencing factors of early mobilization after total knee arthroplasty

Junjie Chen1, Ming Qu2, Jinyu Zhu3,()   

  1. 1. Zhejiang Chinese Medical University, Hangzhou310053, China
    2. Department of Orthopaedics, Fuping County Hospital, Shanxi 711700, China
    3. Department of Orthopaedics, The Affiliated Hospital of Jiaxing University & The First Hospital of Jiaxing, Jiaxing 314001, China
  • Received:2024-10-14 Published:2025-04-01
  • Corresponding author: Jinyu Zhu
引用本文:

陈俊杰, 屈明, 朱锦宇. 全膝关节置换术后早期下床影响因素的研究进展[J/OL]. 中华关节外科杂志(电子版), 2025, 19(02): 236-242.

Junjie Chen, Ming Qu, Jinyu Zhu. Research progress on influencing factors of early mobilization after total knee arthroplasty[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(02): 236-242.

全膝关节置换(TKA)术后早期下床活动是ERAS的中心环节,早期下床活动的安全性是优先要考虑的问题,防止跌倒是重中之重。本文从一般状况,营养,预康复,疼痛管理,手术入路,假体类型,止血带和股四头肌肌力等方面综述了影响TKA术后早期下床活动的研究进展。优化术前一般状况和血红蛋白,补充必需氨基酸可以减轻TKA术后肌肉萎缩并加速功能恢复。术中罗哌卡因或布比卡因脂质体等长效镇痛药物“鸡尾酒”注射可以提供术后持久的镇痛效果,同时不影响股四头肌的功能,更加有助于术后早期下床。术中尽量短时间有限使用或者不使用止血带,以避免对早期下床活动有负面影响。股四头肌肌力、氨甲环酸应用、机器人以及导航等智能化辅助技术等对TKA术后早期下床活动的影响还有待深入研究。

Early mobilization after total knee arthroplasty is a central aspect of ERAS,and there are many factors that affect early mobilization. The safety of early mobilization is a top priority, and preventing falls is of utmost importance. This article reviewed the research progresses on influencing factors including general conditions, nutrition, pre-rehabilitation, postoperative pain management, surgical approach, prosthesis type,tourniquet usage, and quadriceps muscle strength on early postoperative mobilization, for clinical practice reference. The "cocktail" injection of long-acting analgesics such as ropivacaine or bupivacaine liposomes intraoperatively can provide long-lasting postoperative pain relief without affecting the function of the quadriceps muscle, which is more helpful for early mobilization. Surgeons shall try not using tourniquets during surgery or using tourniquets for a short period of time to avoid negative effects on early mobilization. The impact of quadriceps muscle strength, application of tranexamic acid, and intelligent assistive technologies such as robots, navigation on early postoperative mobilization needs further research.

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