| ObjectiveTo explore the effect of minimally invasive versus conventional total knee arthroplasty on the level of inflammatory factors and the rehabilitation of joint function in the early postoperative period,to understand the differences of skin temperature of knee joint and limb swelling in patients after operation,and to analyze the correlation between skin temperature of knee joint and early inflammatory factors,limb swelling and pain,so as to provide reference for early rehabilitation nursing after total knee arthroplasty.MethodsBy means of convenient sampling,82 patients who underwent unilateral total knee arthroplasty in the joint surgery department of a third-level a hospital in Qingdao from September 2018 to April 2019 were selected,and divided into observation group and control group according to the random number table method,with 41 cases in each group.The observation group underwent minimally invasive total knee arthroplasty,while the control group underwent conventional total knee arthroplasty.The differences in incision length,operation time,intraoperative blood loss,straight leg elevation time and first out-of-bed activity time were compared between the two groups.Blood samples were collected on preoperative,postoperative day 1,day 2,day 3,and day 4,respectively,to detect the levels of inflammatory markers such as C-reaction protein(CRP),interleukin-6(IL-6),interleukin-1beta(IL-1β),tumor necrosis factor-alpha(TNF-a).Preoperative,postoperative day 1,day 2,day 3,day 4,postoperative month 1,3,6 visual analogue score(VAS),skin temperature difference between the affected side and the healthy side of the knee joint,limb circumference difference of 5cm above the patella,and range of motion were measured in the two groups.Preoperative,discharge,postoperative month 1,3,and 6,hospital for special surgery knee score(HSS)was evaluated between two groups.SPSS 20.0 statistical software was used for data analysis.Results1.There were no significant difference in Preoperative general data such as age,gender,body mass index(BMI),operative profile,serum CRP,IL-6,IL-1β,TNF-a level,VAS score,bilateral skin temperature difference of knee joint,limb circumference difference,knee joint motion and HSS score between two groups(P>0.05).2.The operation situation of the two groups was compared,the observation group was better than the control group in terms of incision length,straight leg elevation time and first out-of-bed activity time(P<0.001),the operative time of the observation group was longer than that of the control group(P<0.001),but there was no statistically significant difference in intraoperative blood loss between the two groups(P>0.05).3.Repeated measurement variance results showed that the time effect,intergroup effect and interaction effect of serum CRP at different time points in the two groups were statistically significant(P<0.001).The time effect of serum IL-6 and TNF-a at different time points were statistically significant(P<0.05).The time effect and interaction effect of serum IL-1β at different time points was statistically significant(P<0.05).Further pairwise comparison showed that serum CRP in the observation group was lower than that in the control group on postoperative day 1,day 2,day 3,day 4(P<0.001).4.Repeated measurement variance results showed that the time effect,intergroup effect and interaction effect of VAS score,bilateral skin temperature difference of knee joint and limb circumference difference at different time points in the two groups were statistically significant(P<0.05).Further pairwise comparison showed that observation group of patients in postoperative day 1,day 2,day 3,day 4,postoperative month 1,3VAS score,bilateral skin temperature difference of knee joint and limb circumference difference were lower than the control group(P<0.05).5.Repeated measurement variance results showed that the time effect,intergroup effect and interaction effect of range of motion at different time points in the two groups were statistically significant(P<0.001).Further pairwise comparison showed that observation group of patients in postoperative day 1,day 2,day 3,day 4,postoperative month 1,3,6 range of motion were higher than the control group(P<0.05).6.Repeated measurement variance results showed that the time effect,intergroup effect and interaction effect of HSS score in the two groups at different time points were statistically significant(P<0.001).Further pairwise comparison showed that observation group of patients at discharge,postoperative month 1,3 HSS score were higher than the control group(P<0.001).7.Pearson correlation analysis results showed that the bilateral skin temperature difference of the knee joint in the two groups was positively correlated with CRP,IL-6,limb circumference difference and VAS score.ConclusionsAfter minimally invasive total knee arthroplasty,the serum CRP level in early stage was lower than that in conventional total knee arthroplasty.Minimally invasive total knee arthroplasty is less traumatic for patients,to a certain extent,can reduce the inflammatory response.Minimally invasive total knee arthroplasty is superior to conventional total knee arthroplasty in postoperative pain,knee skin temperature and limb swelling,which is conducive to postoperative recovery of knee joint function.In addition,there was a positive correlation between bilateral skin temperature difference of the knee joint and CRP,IL-6,limb circumference difference and VAS score,which has important reference value for guiding rehabilitation nursing and monitoring infection of patients after total knee arthroplasty. |
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