膝关节表面置换术关节内应用氨甲环酸对失血量影响的研究

发布时间：2018-04-25 08:37

本文选题：膝关节 + 关节成形术　；参考：《河北医科大学》2017年硕士论文

【摘要】：随着我国经济的不断发展,人民生活水平较以前明显提高,我国人口老龄化问题越来越重,受膝关节骨关节炎疾病困扰的患者越来越多。膝关节骨关节炎严重影响了人们的生活质量。但人们对生活质量的要求却越来越高。于是越来越多的人选择了人工膝关节表面置换手术治疗。如今,人工假体材料更新换代,假体设计更趋于合理,假体使用寿命越来越长。TKA手术具备有效缓解膝关节疼痛,良好的膝盖功能重建等优点,已成为膝关节骨关节炎的首选治疗方法。但TKA术后截骨骨创面和髓腔内出血量大,有些患者手术之后不得不同种异体输血。但临床用血血源紧张,患者和临床医生饱受同种异体输血窗口时期感染疾病的困扰。一种减少手术创伤引起的出血的新方法,降低术后输血的风险及相应的损失的新方法应运而生。目前国内外有很多报道在TKA术中静脉或局部使用氨甲环酸可以减少术后失血。但目前对于怎样使用氨甲酸可以达到最好的效果,没有统一的意见。氨甲环酸使用局部关节腔和使用静脉注射效果也有很大的争议。无论在国内还是国外有很多相关的研究和报告,但没有统一的结论。局部使用氨甲环酸应在手术操作结束后将引流管夹闭一段时间,其目的是增加局部氨甲环酸的浓度,药物效果发挥到最大。所以本研究术后夹闭引流管4小时,使氨甲环酸作用时间尽量延长,以发挥最大效果。目的:探讨膝关节腔局部应用氨甲环酸对初次膝关节表面置换术后失血量及并发症发生率的影响。方法:利用河北医科大学第三医院病案系统收集2014年8月~2014年12月于我科室行单侧人工膝关节表面置换术并适用于后交叉韧带保留型骨水泥固定人工膝关节假体(德国Link公司),由同一位资深关节外科专家主刀的人工膝关节表面置换术病例,依照纳入、排除标准一一进行筛选。共104例患者纳入试验,根据是否使用氨甲环酸分成使用氨甲环酸(15mg/kg)组为A组和未使用氨甲环酸组为B组。止血带充气后采用膝关节前正中纵行切口,髌旁内侧入路进入关节腔,完成膝关节股骨、胫骨截骨,髌骨均不置换。安装膝关节人工假体试模,活动膝关节以测试活动度及稳定性。然后拆除试模,冲洗截骨面,安装骨水泥型假体。A组在放置引流管缝合关节囊松止血带前5分钟由引流管向膝关节腔内注入稀释后到的20毫升0.9%氯化钠注射液的氨甲环酸(15 mg/kg),B组放置引流后注入等量生理盐水。松止血带后严密止血,关节腔内放置引流管,逐层缝合术区切口,患肢加压包扎。术后两组均夹闭引流管4小时。分析比较两组性别、年龄、病程、术中出血量、术后引流量、术后总失血量、隐性出血量、术后血红蛋白含量、术后红细胞比容、术后并发症等因素,术后第4天行下肢深静脉超声查有无深静脉血栓形成。结果:两组患者性别、年龄、病程、体重指数、术前D-二聚体比较无统计学差异(P0.05)。两组术中失血量、术后第2天D-二聚体比较,P0.05,无统计学差异;A组术后24 h引流量、总引流量、总失血量、隐性失血量均明显低于B组,两组比较P0.05,差异有统计学意义;术后第2天A组红细胞比容、血红蛋白含量明显高于B组,两组比较P0.05,差异有统计学意义(见表2)。术后A组和B组分别有7例(13%)和12例(37%)患者输血,组间比较P0.05,差异有统计学意义。下肢深静脉血栓发生率两组比较P0.05,差异无统计学意义。两组均无发生肺栓塞病例。结论:在初次人工膝关节表面置换术中关节内应用氨甲环酸可以显著减少术后失血量,降低输血率及输血量,且不增加血栓栓塞以及术后感染等并发症的发生率。
[Abstract]:With the continuous development of our country's economy, the living standard of the people has been greatly improved. The problem of population aging is becoming more and more serious in our country. More and more patients are suffering from osteoarthritis of the knee joint. Osteoarthritis of the knee has seriously affected the quality of life of the people. But the demands for the quality of life are getting higher and higher. People choose artificial knee joint surface replacement surgery. Nowadays, prosthesis material is updated, prosthesis is more reasonable, and the life of prosthesis is longer and longer..TKA operation has the advantages of effective relief of knee joint pain and good knee function reconstruction, and it has become the first choice for osteoarthritis of knee joint. But after TKA operation, it is the first choice for the treatment of osteoarthritis of the knee. Some patients have to be allogeneic blood transfusion after surgery. However, the patients and clinicians are plagued by the disease in the period of the allogeneic transfusion window. A new method of reducing the bleeding caused by surgical trauma, reducing the risk of postoperative blood transfusion and the corresponding loss of blood transfusion, is a new method for the patients and clinicians. At present, there are many reports that intravenous or local use of methicocyclic acid in TKA can reduce postoperative bleeding. However, there is no unified opinion on how to use carbamate to achieve the best effect. There is also a lot of controversy over the use of local articular cavity and intravenous injection. There are many related studies and reports abroad, but there is no unified conclusion. The local use of methicocyclic acid should be closed for a period of time after the operation. The aim is to increase the concentration of local methicate, and the effect of the drug is maximum. Therefore, after the operation, the drainage tube is closed for 4 hours to make methicate action. Purpose: To explore the effect of the local application of methicyclic acid on the loss of blood and the incidence of complications after primary knee replacement in the knee joint cavity. Methods: using the medical record system of the Third Hospital of Hebei Medical University to collect the unilateral knee arthroplasty in our department in December ~2014 August 2014. A total of 104 cases of artificial knee joint prosthesis with retained posterior cruciate ligament (Link company, Germany), which was selected by the same senior joint surgeon, were selected for the replacement of the knee joint surface replacement. A total of 104 patients were included in the trial to divide the use of methicate into the use of methicyclic acid. (15mg/kg) group A and unused methicinic acid group as group B. After the tourniquet was inflated, the knee joint anterior medial longitudinal incision was adopted, and the medial paracellar approach entered the joint cavity. The knee joint femur, tibial osteotomy, and patella were not replaced. The knee joint prosthesis was installed to test the activity and stability of the knee joint. Then the test model was dismantled, and the test model was dismantled and washed. The bone cement type.A group was fitted with a cement type prosthesis in group.A, 5 minutes before placing the drainage tube suture suture tourniquet to the knee joint. After the drainage tube was injected into the knee joint, the 20 milliliter of Sodium Chloride Injection's methiculic acid (15 mg/kg) was injected into the knee joint, and the group B was placed and injected into the same amount of saline after drainage. Flow tube, layer by layer suture area incision, pressure bandage of affected limb. Two groups were clamp drainage tube for 4 hours after operation. The sex, age, course of disease, intraoperative bleeding, postoperative flow rate, postoperative total bleeding, recessive haemorrhage, postoperative hemoglobin content, hematocrit after operation, postoperative complications and other factors were analyzed and compared in two groups. The deep veins of lower limbs were performed on fourth days after operation. The results showed that there was no significant difference in sex, age, course of disease, body mass index, D- two polymer in the two groups (P0.05). There was no significant difference in the amount of blood loss in the two groups, the second days after the operation, D- two polymer, P0.05, and there was no statistical difference between the two groups. The volume of the total bleeding, the total loss of blood and the recessive blood loss were significantly lower than that of B after operation in group A. Group, two groups compared P0.05, the difference was statistically significant, second days after the operation, group A erythrocyte specific volume, hemoglobin content was significantly higher than the B group, two groups of P0.05, the difference was statistically significant (see Table 2), 7 cases (13%) and 12 (37%) patients in group A and B, respectively, P0.05, the difference was statistically significant. Lower extremity deep vein thrombosis. There was no significant difference in the rate of P0.05 in the two groups. There was no pulmonary embolism in the two groups. Conclusion: the application of methicyclic acid during the initial artificial knee replacement surgery can significantly reduce the amount of blood loss, reduce the rate of blood transfusion and blood transfusion, and do not increase the incidence of complications such as thromboembolism and postoperative infection.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

【参考文献】