中国组织工程研究

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减少人工膝关节置换失血:两种方法的比较

卢耀甲,熊传芝,李小磊,胡翰生,陈 岗,王 强,卢志华   

  1. 江苏省苏北人民医院关节外科,扬州大学临床医学院,江苏省扬州市 225001
  • 修回日期:2017-01-13 出版日期:2017-03-08 发布日期:2017-03-08
  • 通讯作者: 熊传芝,博士,主任医师,江苏省苏北人民医院关节外科,江苏省扬州市 225001
  • 作者简介:卢耀甲,男,1984 年生,甘肃省庆阳市人,汉族,2011年北京大学毕业,博士,主治医师,主要从事关节外科方面的研究。
  • 基金资助:

    国家自然科学基金资助项目(81501870)

Comparison of two methods for reducing blood loss during total knee arthroplasty

Lu Yao-jia, Xiong Chuan-zhi, Li Xiao-lei, Hu Han-sheng, Chen Gang, Wang Qiang, Lu Zhi-hua   

  1. Joint Surgery Department, Northern Jiangsu People’s Hospital, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu Province, China
  • Revised:2017-01-13 Online:2017-03-08 Published:2017-03-08
  • Contact: Xiong Chuan-zhi, M.D., Chief physician, Joint Surgery Department, Northern Jiangsu People’s Hospital, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu Province, China
  • About author:Lu Yao-jia, M.D., Attending physician, Joint Surgery Department, Northern Jiangsu People’s Hospital, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81501870

摘要:

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文题释义:
人工膝关节置换:是指采用金属、高分子聚乙烯等材料,根据人体膝关节的形态、构造及功能制成人工膝关节假体,通过外科手术植入人体内,代替患病的膝关节,从而缓解膝关节疼痛,恢复膝关节功能的一种技术。
止血带原理:止血带止血是用于四肢大出血急救时简单、有效的止血方法,它通过压迫血管阻断血行来达到止血目的。但如使用不当或使用时间过长,止血带可造成远端肢体缺血、坏死,造成残废,为此,只有在出血猛烈,用其它方法不能止血时才能应用止血带。 止血带以橡皮条或橡皮管为好,不宜用布带、电线等无弹性的带子。绑扎位置应在伤口的上方(近心端),并尽量靠近伤口,以上臂的上1/3和大腿上中部为好,小腿和前臂不能上止血带,因该处有两根骨头,血管正好走在两骨之间,上止血带起不到压迫血管的作用。上臂的中1/3部位亦不能上止血带,因它可能引起神经损伤而致手臂瘫痪。
 
摘要
背景:减少手术失血在一定程度上可以预防人工膝关节置换的并发症,可以减轻术后患肢肿胀和不适,有利于患者术后康复。
目的:探讨减少人工膝关节置换失血的方法。
方法:将单侧初次人工膝关节置换的患者分为2组。对照组(27例)采用传统的手术方法,全程使用止血带,并留置引流管;实验组(36例)对手术方法进行改良,只有在安装假体时使用止血带,对软组织出血予以充分止血,缝合关节囊后在关节腔内注射止血药液,置换后不留置引流管。比较2组患者的术前、置换后血红蛋白、置换后血红蛋白的下降值、膝关节疼痛评分、关节活动度、输血率、伤口愈合情况等临床结果。
结果与结论:①两组患者关节置换前血红蛋白差异无显著性意义,置换后第1,4,7天对照组血红蛋白均显著低于实验组,而且对照组血红蛋白跟置换前相比的下降值均显著高于实验组;②两组的膝关节疼痛评分差异无显著性意义;③置换后第7天实验组膝关节活动度显著大于对照组。④对照组置换后输血率为18.5%,1例患者伤口愈合不良;实验组置换后没有患者需要输血,所有患者伤口均正常愈合。⑤两组患者均未出现置换后感染、血肿形成等并发症。⑥结果说明,通过改良手术方法,可以减少人工膝关节置换术的失血量,避免膝关节置换后输血,有助于置换后康复。
 
中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

ORCID: 0000-0002-2670-8299(卢耀甲)

关键词: 骨科植入物, 人工关节, 膝, 膝关节置换, 失血, 止血带, 引流术, 国家自然科学基金

Abstract:

BACKGROUND: Reducing blood loss could help to prevent the complications of total knee arthroplasty, relieve the swelling and discomfort postoperatively and accelerate the rehabilitation.

OBJECTIVE: To explore the methods for reducing blood loss during total knee arthroplasty.
METHODS:Totally 63 patients undergoing primary unilateral total knee arthroplasty were divided into two groups. Group 1 included 27 patients who received the conventional surgical techniques using tourniquet during the whole procedure with wound drainage, as control group. Group 2 included 36 patients who received the modified procedure only using tourniquet during prosthesis implantation without wound drainage, as experimental group. In the experimental group, we stitched the capsule closely. The preoperative and postoperative hemoglobin, decrease of hemoglobin, knee pain score, range of motion blood transfusion rate and wound healing were compared between the two groups. 
RESULTS AND CONCLUSION: (1) There was no significant difference in preoperative hemoglobin between the two groups. At 1, 4 and 7 days postoperatively, the hemoglobins were significantly lower in the control group than in the experimental group, and the decreases of hemoglobins were significantly lower in the control group than in the experimental group. (2) Knee pain score was not significantly different between the two groups. (3) The range of motion of the knee was significantly larger in the experimental group than in the control group at 7 days. (4) Blood transfusion rate was 18.5% in the control group, and wound healing was poor in one patient. There was no transfused case and wound problem in the experimental group. All wounds were healed normally. (5) There was no infection or hematoma in two groups. (6) With the modified procedure, we could reduce blood loss during total knee arthroplasty without blood transfusion after surgery, which was helpful to postoperative rehabilitation. 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Knee, Arthroplasty, Replacement, Knee, Blood Loss, Surgical, Tourniquets

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