术后患肢不同体位对初次膝关节表面置换术失血量的影响

发布时间：2018-05-12 06:07

本文选题：膝骨性关节炎 + 膝关节表面置换术　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:探讨膝关节表面置换术后患肢屈膝位和伸直位对围手术期失血量的影响,以期为临床工作提供帮助和指导。方法:选择2015年1月—2016年6月在我院实施的初次单侧TKA手术的骨性关节炎患者60名纳入研究中,随机分为实验组、对照组等2组。实验组为A组(30名,男性患者7名,女性患者23名,其中行左侧手术18名,行右侧手术12名,平均年龄64岁):术后用特定角度制作下肢垫使患肢屈髋大腿抬氋45°,屈膝60°6h;对照组为B组(30例,男性患者6名,女性患者24名,其中行左侧手术19名,行右侧手术11名,平均年龄67岁):患肢术后髋、膝关节伸直位。记录全部患者基本身体信息。登记术前、术后24h红细胞比容值、计算并登记术中出血量、术后24h切口引流量和异体血输注量,同时记录所有患者住院天数和术后第5天膝关节活动度,仔细观察手术切口有无裂开、有无脓性分泌物及注意切口愈合情况,术后7天所有患者行下肢血管彩色多普勒超声检查明确是否存在血栓的形成。结果:1.两组患者基本身体状况信息及手术肢体侧无统计学差异;术前常规化验如24h红细胞压积Hct也无明显统计学差异。2.术后住院天数无明显差异,分别为13.3天和13.4天,p=0.9;术后第5天两组膝关节活动度无统计学差异,分别为113°和117°,p=0.13;两组患者均无切口愈合不良及感染发生;两组患者术后7天各出现1例下肢深静脉血栓形成患者;术中出血量无差异,分别为206ml和210ml,p=0.84。3.术后24h实验组及对照组切口引流量有统计学差异,分别为172ml和272ml,p=0.030.05;实验组及对照组计算总失血量有统计学差异,分别为803ml和1059ml,p=0.0030.05;实验组及对照组根据GROSS方程计算隐性失血有统计学差异,分别是428ml和576ml,p=0.0340.05。结论:TKA术后保持患肢屈髋大腿举氋45°、屈膝60°6h与患肢伸直位比较可以降低术后总失血量、引流量及隐性失血量,同时并不增加患者住院时间、并发症发生率及影响患肢功能,所以TKA术后采用该体位是一个简便可行、安全有效降低术后失血的方式,可考虑试推广于临床。
[Abstract]:Objective: to investigate the effect of knee flexion and extension position on perioperative blood loss after knee surface replacement in order to provide help and guidance for clinical work. Methods: from January 2015 to June 2016, 60 patients with osteoarthritis undergoing primary unilateral TKA operation in our hospital were randomly divided into two groups: experimental group and control group. The experimental group consisted of 30 patients in group A, 7 males and 23 females. Among them, 18 were operated on the left side and 12 on the right. The average age was 64 years old: after operation, the lower extremity pad was made with a specific angle for 45 掳of flexion of hip and thigh and 60 掳6 h of knee flexion in the affected extremities, while the control group consisted of 30 cases in group B, 6 males and 24 females, of which 19 underwent left operation and 11 underwent right operation. Mean age 67 years: hip and knee extension after operation. Record basic body information of all patients. The specific volume of erythrocyte was recorded before and 24 hours after operation, the amount of intraoperative bleeding was calculated and registered, the incision drainage volume and the volume of allogeneic blood transfusion were recorded at the same time, the days of hospitalization and the knee joint movement on the 5th day after operation were recorded. After 7 days of operation, all the patients were examined by color Doppler ultrasound to determine whether there was thrombosis or not. The result is 1: 1. There was no significant difference between the two groups in the basic physical condition information and the limb side of the operation, and there was no significant difference between the two groups in preoperative routine tests such as 24h hematocrit Hct. 2. There was no significant difference in postoperative hospitalization days (13.3 days and 13.4 days) between the two groups, and there was no significant difference in knee joint motion between the two groups on the 5th day after operation (113 掳and 117 掳/ 0.13 respectively). There was no difference in the amount of blood loss between the two groups (206ml and 210ml) on the 7th day after operation. 24 hours after operation, there were significant differences in incision drainage volume between the experimental group and the control group (172ml and 272 ml) 0.030.05.The total blood loss in the experimental group and the control group was significantly different from that in the control group. There were significant differences in the recessive blood loss between the experimental group and the control group according to the GROSS equation, 428ml and 576 ml, respectively. Conclusion keeping flexion hip and thigh lift 45 掳and flexion knee 60 掳6 h after 1: TKA can reduce the total blood loss, drainage volume and recessive blood loss, and does not increase the hospital stay, the incidence of complications and affect the function of the affected limb, compared with the extension position of the affected limb. Therefore, it is simple and feasible to adopt this position after TKA, and it is safe and effective to reduce postoperative blood loss.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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