目的：探讨个性化手术导板（patient⁃specific instruments, PSI）对现代血液保护条件下全膝关节置换术围术期失血量的影响。方法本研究是一项前瞻性对照研究。2015年5月至2016年1月，按照纳入和排除标准纳入106例需行单侧全膝关节置换术的骨关节炎患者，根据入组的患者是否接受CT检查及PSI辅助手术分为PSI组（54例，接受PSI辅助的全膝关节置换术）和对照组（52例，行传统全膝关节置换术）。所有患者均行后稳定型表面膝关节置换术，接受统一的血液保护和抗凝方案。记录患者术后引流量，术后1、3、5 d的血常规，人均输血量和输血率；术后7~10 d接受双下肢静脉超声检测下肢深静脉血栓形成（deep venous thrombosis, DVT）的发生情况。结果 PSI组总失血量和引流量分别为（579±312）ml、（182±163）ml，而对照组的两项数据分别为（622±326）ml和（208±224）ml；PSI组的输血率为12.96%（7/54），对照组为13.46%（7/52）；两组患者的DVT发生率分别为20.37%（11/54）、17.31%（9/52）。以上各项指标比较，两组患者的差异均无统计学意义（均P＞0.05）。结论在运用多模式血液保护技术的前提下，PSI的使用不能降低全膝关节置换术围术期的失血量和输血需求，但其在改善力线方面的潜在优势仍值得进一步研究。%Objective To explore the influence of patient⁃specific instruments (PSI) on blood loss under contemporary blood⁃saving strategy in total knee replacement (TKA). Methods In this prospective con⁃trolled trial, 106 patients who needed unilateral TKA were selected according to the inclusion exclusion criteria from May 2015 to January 2016, and they were divided into PSI group (54 cases with the PSI technique) and control group (52 cases with conventional instruments). Drainage and calculated total blood loss were com⁃pared at day 1, day 3 and day 5. Amount and percentage of transfusion were also recorded. The occurrence of deep venous thrombosis (DVT) of lower extremity was detected by double lower limb vein ultrasound after 7⁃10 days. Results The total blood loss was slightly but not statistically significant less for patients in the PSI group[(579±312) ml]than for the control group[(622±326) ml]. The overt blood loss was comparable be⁃tween patients in the PSI group[(182±163) ml]and control group[(208±224) ml]. The Amount and percent⁃age of transfusion and the incidence of DVT were insignificantly discrepant between two groups. Conclusion The use of PSI⁃assisted TKA did not result in less blood loss than conventional TKA, but the potential advan⁃tage of PSI in alignment improvement and outlier decrease guarantee its further research.
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