快速康复方案下全膝关节置换术后采用加压治疗预防血栓栓塞性疾病：一项系统综述。
完整摘要 · 中文译文
血栓栓塞性疾病（TED），包括深静脉血栓形成（DVT）和肺栓塞（PE），仍然是全膝关节置换术（TKA）后严重的术后风险。加速康复外科（ERAS）方案强调早期活动，因此有必要重新评估机械预防措施，如加压治疗。本系统评价评估了在ERAS方案联合药物预防下，加压治疗对预防TKA患者发生TED的益处。我们开展了一项系统评价，分析了7项比较机械联合药物预防与单纯药物预防的研究。主要结局包括DVT和PE发生率、依从性、不良事件及疗效。本系统评价共纳入7项研究，包括871例患者。机械联合药物预防降低了DVT发生率。持续增强循环治疗（CECT）联合依诺肝素将DVT从19.5%降至6.6%（相对危险度降低（RRR）66.2%，p=0.018），而间歇性充气加压（IPC）联合利伐沙班将发生率从18.3%降至8.3%（RRR 54.5%，p<0.01）。足底气压加压（PPC）使单侧TKA的DVT从67%降至27%，双侧TKA从52%降至28%（合并RRR 54.2%，p<0.001）。梯度压力袜（GCS）联合抗凝治疗将DVT从13.0%降至6.0%（RRR 53.8%，p=0.0872）。IPC联合那屈肝素将DVT从3.9%降至2.6%（RRR 33.3%，p=0.65）。各项研究中PE发生率均极低。当与抗凝药物联合使用时，机械预防可能具有 在减少深静脉血栓（DVT）发生率的同时，还能减轻术后肿胀和疼痛。然而，优化依从性、规范方案以及根据患者个体风险定制血栓预防策略仍是关键挑战。未来的研究应进一步完善机械性和药物性策略，以提高全膝关节置换术（TKA）患者的安全性、有效性和康复效果。
完整摘要 · 英文原文
Thromboembolic disease (TED), including deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a serious postoperative risk after total knee arthroplasty (TKA). Enhanced recovery after surgery (ERAS) protocols emphasize early mobilization, warranting reassessment of mechanical prophylaxis, such as compression therapy. This systematic review evaluates the benefits of compression therapy in preventing TED in TKA patients under ERAS protocols combined with pharmacological prophylaxis. A systematic review was conducted, analyzing seven studies comparing combined mechanical and pharmacological prophylaxis with pharmacological prophylaxis alone. Primary outcomes included DVT and PE incidence, compliance, adverse events, and efficacy. Seven studies were included in this systematic review, including 871 patients. Combined mechanical and pharmacological prophylaxis reduced DVT rates. Continuous enhanced circulation therapy (CECT) with enoxaparin lowered DVT from 19.5% to 6.6% (relative risk reduction (RRR) 66.2%, p=0.018), while intermittent pneumatic compression (IPC) with rivaroxaban reduced rates from 18.3% to 8.3% (RRR 54.5%, p<0.01). Pneumatic plantar compression (PPC) decreased DVT from 67% to 27% in unilateral and 52% to 28% in bilateral TKA (combined RRR 54.2%, p<0.001). Graduated compression stockings (GCS) with anticoagulation reduced DVT from 13.0% to 6.0% (RRR 53.8%, p=0.0872). IPC with nadroparin lowered DVT from 3.9% to 2.6% (RRR 33.3%, p=0.65). PE incidence remained minimal across studies. When combined with anticoagulants, mechanical prophylaxis may have an additional role in diminishing DVT incidence while alleviating postoperative swelling and pain. However, optimizing compliance, standardizing protocols, and tailoring thromboprophylaxis to patient-specific risks remain key challenges. Future research should refine mechanical and pharmacological strategies to enhance safety, efficacy, and recovery in TKA patients.