减少人工膝关节置换失血:两种方法的比较

发布时间：2018-08-31 17:20

【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。
[Abstract]:Background: to a certain extent, reducing blood loss can prevent the complications of artificial knee arthroplasty, alleviate the swelling and discomfort of the affected limbs, and is beneficial to the postoperative rehabilitation of the patients. Objective: to study the method of reducing blood loss in artificial knee arthroplasty. Methods: the patients were divided into two groups. In the control group (27 cases), the traditional operative method was used, tourniquet was used in the whole process, and the drainage tube was retained. In the experimental group (36 cases), the operative method was improved, only when the prosthesis was installed, the tourniquet was used to fully stop the bleeding of soft tissue. After the joint capsule was sutured, the hemostatic fluid was injected into the articular cavity, and the drainage tube was not retained after replacement. The clinical results of the two groups were compared, such as the decrease of hemoglobin before and after replacement, knee joint pain score, joint motion, blood transfusion rate, wound healing and so on. Results and conclusion: (1) there was no significant difference in hemoglobin before joint replacement between the two groups. The hemoglobin in the control group was significantly lower than that in the experimental group on the 7th day after arthroplasty. The decrease of hemoglobin in the control group was significantly higher than that in the experimental group; (2) there was no significant difference in knee pain score between the two groups; (3) the knee joint motion in the experimental group was significantly higher than that in the control group on the 7th day after replacement. In the control group, the rate of blood transfusion after replacement was 18.5% and 1 patient had poor wound healing. No patients in the experimental group needed blood transfusion and all the wounds healed normally. (5) there were no complications such as infection, hematoma formation and other complications in the two groups. (6) the results showed that, through the modified surgical method, no complications such as infection and hematoma formation were found in the two groups. It can reduce blood loss after knee arthroplasty, avoid blood transfusion after knee arthroplasty, and be helpful to rehabilitation after knee arthroplasty.
【作者单位】：江苏省苏北人民医院关节外科扬州大学临床医学院;
【基金】：国家自然科学基金资助项目(81501870)~~
【分类号】：R687.4;R318.17

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