止血带释放时机对全膝关节置换术后早期康复影响的临床研究

发布时间：2018-05-11 06:26

本文选题：骨关节炎 + 全膝关节置换术　；参考：《浙江大学》2015年博士论文

【摘要】：研究目的：研究全膝关节置换术中全程和前半程使用止血带对患者术后早期康复效果的影响。研究方法：选择2014年6月1日至2015年1月31日于浙江大学医学院附属第二医院入院和出院主诊断均为左(或右)膝骨关节炎,并且初次行全膝关节置换术,术中分别为全程和前半程使用止血带的患者各40名,依据住院病历系统的资料进行回顾性研究。对两组患者的手术时间,术中失血量、围手术期输血率、材料费用、术后住院时间、实验室检查、红细胞丢失量以及术后严重并发症的发生率等系列指标进行对比分析。研究结果：与全程使用止血带相比,前半程组的劣势主要有延长手术时间(68.68±10.73v.s.87.65±11.45min;P0.001),也增加了术中失血量(97.88±39.89v.s.127.50±49.29mL;P=0.004).它的优势主要有减少总红细胞丢失量(53.73±147.38v.s.344.51±125.88mL；P=0.017)和隐性红细胞丢失量(310.40±137.68v.s.215.13±119.31mL;P=0.025),缩短了术后住院时间(9.60±3.42v.s.7.05±2.89天；P=0.001),并且患者术后下肢关节功能恢复器的辅助弯曲角度可以更快达到90。(4.74±1.69v.s.4.00±1.11天；P=0.028)。两组患者在围手术期输血率、显性红细胞丢失量上无显著性差异。研究结论：全膝关节置换术中止血带的应用已经被众多关节外科医生所接受,在创口缝合之前释放止血带进行止血,不仅能减少患者围手术期失血量,还缩短住院时间,有利于患者早期功能锻炼,同时不会增加血管栓塞及术后严重感染等并发症的发生率。
[Abstract]:Objective: to study the effect of tourniquet on early postoperative rehabilitation after total knee arthroplasty. Methods: from June 1, 2014 to January 31, 2015, the main diagnosis of left (or right) knee osteoarthritis was performed at the second affiliated Hospital of Zhejiang University School of Medicine, and total knee arthroplasty was performed for the first time. A retrospective study was carried out in 40 patients using tourniquet during the whole and the first half of the operation, respectively, according to the data of the inpatient medical record system. The operation time, intraoperative blood loss, perioperative blood transfusion rate, material cost, postoperative hospitalization time, laboratory examination, red blood cell loss and the incidence of severe postoperative complications were compared and analyzed between the two groups. Results: compared with the whole course of tourniquet use, the main disadvantages of the first half group were to prolong the operation time (68.68 卤11.45min) P0.001a, and to increase the blood loss during operation (97.88 卤49.29mL / P 0.004). The main advantages were to reduce the total RBC loss (53.73 卤125.88mLP0.017) and occult RBC loss (310.40 卤119.31mLP0. 025), which shortened the postoperative hospitalization time (9.60 卤3.42v.s.7.05 卤2.89 days), and the auxiliary bending angle of the lower limb joint function restorer could reach 90.0.4.74 卤1.11 days P0.028. There was no significant difference in blood transfusion rate and dominant red blood cell loss between the two groups during perioperative period. Conclusion: the application of tourniquet in total knee arthroplasty has been accepted by many joint surgeons. The release of tourniquet before suture of the wound can not only reduce the amount of blood loss in perioperative period, but also shorten the length of hospital stay. It is beneficial to early functional exercise and does not increase the incidence of complications such as vascular embolism and severe postoperative infection.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R687.4

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