全膝关节置换术应用与不应用止血带的随机对照研究

发布时间：2018-02-11 07:42

本文关键词： 全膝关节置换术止血带氨甲环酸加速康复　出处：《中国矫形外科杂志》2017年17期 　论文类型：期刊论文

【摘要】：[目的]比较全膝关节置换术中应用止血带和不应用止血带的效果。[方法]2015年6月~2015年12月连续纳入90例拟行初次单侧全膝关节置换术的患者,随机分为两组:止血带组(全程使用止血带)和无止血带组(全程不使用止血带),比较两组患者的手术时间、失血量及输血率、术后VAS评分、膝关节肿胀程度、骨水泥厚度及术后康复。[结果]通过Gross方程计算两组预计总失血量,得到止血带组总失血量(896.10±245.40)ml多于无止血带组(804.30±215.90)ml,且止血带组的血红蛋白下降值(26.40±11.20)g/L显著高于无止血带组的血红蛋白下降值(18.50±8.30)g/L,差异具有统计学意义(P0.05);其中止血带组有1例需要输血,无止血带组没有输血者(P=1.000)。影像学测得两组骨水泥厚度分别为(0.52±0.02)cm和(0.51±0.02)cm,差异无统计学意义(P=0.096);无止血带组患者术后前3 d膝关节肿胀率均显著低于止血带组,且无止血带组的术后住院天数(3.80±0.29)d显著少于止血带组(5.10±0.22)d。[结论]在初次全膝关节置换术中,全程不应用止血带并不增加失血量,不影响骨水泥厚度,同时可以减轻术后膝关节肿胀程度和VAS评分,有助于快速康复,减少住院时间。
[Abstract]:[objective] to compare the effects of tourniquet and non-tourniquet in total knee arthroplasty. [methods] from June 2015 to December 2015, 90 patients with primary total knee arthroplasty were enrolled. Two groups were randomly divided into two groups: tourniquet group (tourniquet group) and non-tourniquet group (no tourniquet group). The operation time, blood loss and blood transfusion rate, postoperative VAS score, knee joint swelling degree were compared between the two groups. Bone cement thickness and postoperative rehabilitation. [results] the estimated total blood loss was calculated by Gross equation. The total bleeding volume of the tourniquet group was 896.10 卤245.40ml, which was higher than that of the non-tourniquet group (804.30 卤215.90g / ml), and the decrease of hemoglobin in the tourniquet group (26.40 卤11.20g / L) was significantly higher than that in the non-tourniquet group (18.50 卤8.30g / L), the difference was statistically significant (P 0.05), and the blood transfusion was needed in one case in the tourniquet group. The thickness of bone cement was 0.52 卤0.02cm and 0.51 卤0.02cm respectively in the non-tourniquet group, and there was no significant difference between the two groups. The swelling rate of knee joint in the non-tourniquet group was significantly lower than that in the tourniquet group on the first 3 days after operation. The days of hospitalization in the non-tourniquet group were 3.80 卤0.29 days less than that in the tourniquet group 5.10 卤0.22 days. [conclusion] in the initial total knee arthroplasty, tourniquet did not increase the amount of bleeding and did not affect the thickness of bone cement during the first total knee arthroplasty. At the same time, it can reduce the degree of knee joint swelling and VAS score, help to recover quickly and reduce the length of hospital stay.
【作者单位】：四川大学华西医院骨科;
【基金】：卫生部卫生行业科研专项基金项目(编号:2013020007)
【分类号】：R687.4

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