人工全膝关节置换术中滑膜处理方式对术后感染的影响

发布时间：2018-05-30 05:59

本文选题：人工全膝关节置换术 + 滑膜处理　；参考：《中华医院感染学杂志》2017年11期

【摘要】：目的探讨人工全膝关节置换术中滑膜处理方式对术后感染的影响,为临床诊治提供依据。方法依据人工全膝关节置换术中滑膜切除与否将医院2013年1月-2015年10月收治的158例膝骨关节炎患者分为切除组65例与保留组93例,比较两组患者手术时间、出血情况及手术效果,同时手术前后对两组患者炎症反应相关指标测定比较,统计两组术后感染率。结果切除组手术时间、术中出血量、术后引流量均明显多于保留组(P0.05);切除组术后输血率41.54%显著高于保留组17.20%(P0.05);与同组术前1d比较,两组术后1d、2周血清C-反应蛋白(CRP)、总白细胞计数、白介素-6(IL-6)均显著上升(P0.05),术后12周、1年上述指标与术前1d比较差异无统计学意义;两组浅表感染发生率比较差异无统计学意义,而深部感染发生率(4.62%vs 0)比较差异有统计学意义(P0.05);与同组术前1d比较,两组术后4周、术后1年AKSS临床评分、AKSS功能评分均显著上升(P0.05)。结论人工全膝关节置换术中切除滑膜与否对患者炎症反应、患肢功能恢复无明显影响,但滑膜切除会显著增加出血量及术后输血率,延长手术时间,且可能增加术后感染的发生。
[Abstract]:Objective to investigate the effect of synovial management on postoperative infection in total knee arthroplasty (TKA) and to provide evidence for clinical diagnosis and treatment. Methods according to the synovectomy or not in total knee arthroplasty, 158 patients with osteoarthritis were divided into resection group (65 cases) and preservation group (93 cases) from January 2013 to October 2015. The operative time of the two groups was compared. The bleeding and the effect of operation were compared before and after operation, and the infection rate of the two groups was counted. Results the time of operation, the amount of intraoperative bleeding and the postoperative drainage volume in the resection group were significantly higher than those in the retention group (P 0.05), the blood transfusion rate in the resection group was significantly higher than that in the retention group (41.54%), and compared with that in the same group 1 day before operation, the serum C-reactive protein (CRP) and the total white blood cell (WBC) in the two groups were significantly higher than those in the control group. There was no significant difference in the incidence of superficial infection between the two groups at 12 weeks, 1 year after operation and 1 day before operation, but there was no significant difference in the incidence of superficial infection between the two groups, and there was no significant difference in the incidence of superficial infection between the two groups. The incidence of deep infection (4.62 vs 0) was significantly higher than that in the same group (P 0.05). Compared with the same group, the clinical scores of AKSS were significantly increased at 4 weeks and 1 year after operation in both groups (P 0.05). Conclusion removal of synovium in total knee arthroplasty has no effect on inflammatory reaction and functional recovery of affected limbs, but synovectomy can significantly increase blood loss, blood transfusion rate and prolong operation time. And may increase the incidence of postoperative infection.
【作者单位】：嘉兴市第一医院骨科;
【分类号】：R687.4

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