止血带的不同使用方法对初次全膝关节置换术后临床效果的比较研究

发布时间：2018-05-27 11:23

本文选题：止血带 + 全膝关节置换术　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：是讨论止血带的不同使用方法对初次全膝关节置换(TKAtotal knee arthroplasty)术后临床效果的比较，为TKA中止血带的使用方法的选择提供一定的参考依据和临床数据。方法：采用回顾性分析2013年8月--2014年11月吉林大学第三临床医院骨科11楼首次行TKA手术的患者资料。选择符合本文研究标准的80例膝关节骨性关节炎的病人,这些病人随机分为两组，其中A组40例病人手术开始时就使用止血带,而B组40例病人是在胫骨或股骨准备截骨时才开始使用止血带。统计数据中两组符合纳入标准的病人的体重指数、术前的血红蛋白(Hb)含量、红细胞计数（RBC）、红细胞比容（Hct）、疼痛视觉模拟评分(VAS)、关节活动度差别没有统计学意义（P0.05)详见表（1-4）。比较两组病人术后24h的RBC、Hct、Hb含量及术后下肢静脉血栓形成情况(发生率)、隐性失血量、显性失血量及总的失血量,两组输血率及术后3d及术后7d的VAS评分评分，以及术后3d，术后7d，术后3月患侧膝关节的活动度。并以SPSS17.0软件做相关统计分析,其中连续型变量采用t检验,分类变量采用x2检验,计算出对应的统计量和P值。P＜0.05认为组间有统计意义，p0.05认为组间没有统计学意义。结果：术后24h内,两组患者Hb及Hct及RBC比较,结果都没有统计学意义(P0.05)。两组总的失血量比较结果没有统计学意义(F=0.398,P=0.5320.05); A组（手术开始时应用止血带组）显性失血量少于B（准备截骨时应用止血带组）组（P=0.0130.05）,但隐性失血量要多于B组(P=0.0270.05),结果有统计学意义。术后3dB组关节活动度优于A组（F=8.312，P=0.0160.05），，术后5、7d及术后3个月时两组关节活动度比较结果无统计学意义(P0.05)。术后A组中10例(25%)、B组中8例(20%)应用自体血或异体血回输治疗,其中A组与B组输血率比较行统计学分析(X2=0.287,P=0.7900.05)结果无意义(见表5)。病人手术切口都为I级甲等级愈合。B组术后3天VAS评分优于A组（P=0.0060.05）,术后7天的VAS评分差别无统计学意义(P=0.9140.05)。术后行膝关节正侧位检查示,假体未见明显异常。术后血栓发生率A组4例（均为小腿肌间静脉血栓），B组3例（也为肌间静脉血栓），两组均无急性肺栓塞发生，下肢静脉血栓发生率（，P=0.9050.05)结果无统计学意义（详见表6）结论：全膝关节置换手术中全程使用止血带与截骨时使用止血带相比并没有减少自体或异体血的回输，虽然减少了显性失血量，但是增加了隐性失血量，并且在总失血量上两者差别没有统计学差异，因此在对于易患有血栓的高风险患者来说笔者认为应该尽量缩短止血带使用时间及压力。
[Abstract]:Objective: to compare the clinical effects of different tourniquet use methods after TKA total knee arthroplasty (TKA total knee arthroplasty), and to provide some references and clinical data for the choice of tourniquet use methods in TKA. Methods: the data of patients undergoing TKA operation on the 11th floor of Orthopaedics Department of the third Clinical Hospital of Jilin University from August 2013 to November 2014 were retrospectively analyzed. Eighty patients with knee osteoarthritis who met the criteria of the present study were randomly divided into two groups: group A, 40 patients were treated with tourniquet at the beginning of operation, In group B, 40 patients began using tourniquet when tibia or femur was ready for osteotomy. The body mass index (BMI), preoperative hemoglobin (HB) content, erythrocyte count (RBCU), RBC specific volume (HCT), pain visual analogue score (VASA), and no significant difference in joint activity between the two groups were found in Table 1-4. The contents of hcttl HB and venous thrombosis of lower extremity (incidence rate, recessive blood loss, dominant blood loss and total blood loss) were compared between the two groups 24 hours after operation. The blood transfusion rate and the VAS score of 3 days and 7 days after operation were compared between the two groups. And 3 days after operation, 7 days after surgery, 3 months after the operation of the knee motion. SPSS17.0 software was used to do the related statistical analysis, in which the continuous variables were analyzed by t test and the classification variables by x2 test. The corresponding statistics and P < 0. 05 showed that there was statistical significance among the groups. P0. 05 thought there was no statistical significance among the groups. Results: within 24 hours after operation, there was no significant difference in HB, Hct and RBC between the two groups. There was no significant difference in total blood loss between the two groups (P < 0. 398P 0. 5320.05), but the dominant blood loss in group A (tourniquet group at the beginning of operation) was less than that in group B (using tourniquet at the time of osteotomy), but the amount of recessive blood loss was higher than that in group B (P 0. 027. 05). After operation, the range of joint motion in 3dB group was better than that in group A (8. 312%, P 0. 016 0. 05%), but there was no significant difference between the two groups at 5 days after operation and 3 months after operation (P 0. 05). There was no significant difference between group A (10 cases) and group B (8 cases (20 cases) treated with autologous or allogeneic blood transfusion. The blood transfusion rate of group A and group B were compared with that of group B (P 0.7900. 05). There was no significant difference between group A and group B (see table 5). The VAS score of group B was better than that of group A on the 3rd day after operation. There was no significant difference in VAS score between group A and group A on the 7th day after operation (P 0. 914 0. 05). Postoperative knee joint examination showed that the prosthesis was not abnormal. The incidence of postoperative thrombus in group A (3 cases in group B) (3 cases in group B (also intramuscular venous thrombosis), no acute pulmonary embolism in both groups, and the incidence of venous thrombosis in lower extremity (0.9050.05) were not statistically significant (see Table 6 for details). Conclusion: using tourniquet in the whole course of total knee arthroplasty does not decrease the amount of autologous or allogeneic blood transfusion, but it increases the amount of recessive blood loss, although it can decrease the amount of dominant blood loss, compared with the use of tourniquet during osteotomy. There was no statistical difference in the total blood loss between the two groups. Therefore, for the patients with high risk of thrombus, we think we should shorten the tourniquet usage time and pressure as far as possible.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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