直接前入路初次全髋关节置换术后引流放置与否对早期临床疗效的影响

发布时间：2018-07-09 23:06

本文选题：直接前入路 + 髋关节置换术　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:经直接前入路行初次全髋关节置换术(Total Hip Arthroplasty using a Direct Anterior Approach DAA-THA)后,比较放置引流与不放置引流对患者早期疼痛程度、输血率、髋关节活动度、失血量及并发症等临床疗效的影响。方法:采用前瞻性、随机性的对照研究方法,对执行DAA-THA术后放置引流与不放置引流的患者作早期临床疗效对比研究。使用自体血回输机作为引流装置,应用随机分配的方法将25例执行DAA-THA的患者放入引流组,将25例执DAA-THA的患者放入不引流组,共纳入50例髋。观察手术前后大腿根部周径、血红蛋白、红细胞压积、凝血功能、D-2聚体、更换敷料次数、引流量、输血率、疼痛程度、失血量、血肿发生率、瘀斑、血栓发生率、术后住院天数、切口愈合情况、感染发生率、术后下地时间、髋关节活动度等指标,做统计学分析进行比较。结果:在直接前入路初次全髋关节置换术后1d、2d、3d及出院当天放置引流组的髋关节活动度(P0.05)及视觉模拟评分(P0.05)均优于不放置引流组;但术后血红蛋白下降水平则引流组大于不引流组(P=0.031),不放置引流组有2例输血(8%),放置引流组有4例输血(16%);其术后血液丢失总量、术后住院天数、瘀斑、大腿周径差值、更换敷料次数、术后凝血功能、D-2聚体、术后下地时间、拆线时间两组相比较均无明显统计学意义,术后未发现下肢深静脉血栓形成及肺栓塞,均未发现明显血肿形成,两组均无感染,放置引流组和不放置引流组差异无统计学意义(P0.05)。结论:经直接前入路行初次全髋关节置换术,术后引流可以减轻患者术区疼痛感及获得更好的髋关节活动度,但血红蛋白丢失及输血率较不放置引流高,所以权衡利弊,为了使患者术后获得良好早期疗效,建议DAA-THA术后应常规放置引流;另外围手术期合理应用止血药和预防血栓药,术后可以减少相关并发症的发生。
[Abstract]:Objective: total Hip Arthroplasty using a Direct Anterior Approach DAA-THA (Total Hip Arthroplasty using a Direct Anterior Approach DAA-THA) through direct anterior approach was used to compare the degree of pain, blood transfusion rate and hip joint activity between patients with and without drainage. The effect of blood loss and complications. Methods: a prospective, randomized controlled study was conducted to compare the early clinical outcomes of patients with or without drainage after DAA-THA. Using autologous blood transfusion machine as drainage device, 25 patients who performed DAA-THA were put into drainage group by random distribution method, 25 patients with DAA-THA were put into non-drainage group, 50 hips were included. The peripheral diameter of thigh root, hemoglobin, hematocrit, coagulant function and D-2 polymer were observed before and after operation. Dressing change times, drainage rate, blood transfusion rate, pain degree, blood loss, hematoma rate, ecchymosis, thrombus incidence were observed. The hospital stay, wound healing, infection rate, postoperative floor time and hip motion were compared statistically. Results: the hip motion (P0.05) and visual analogue score (P0.05) in the drainage group were better than those in the non-drainage group on the 1st day after the first total hip arthroplasty through the direct anterior approach (P 0.05) and the drainage group on the day of discharge. However, the decrease of hemoglobin level in drainage group was higher than that in non-drainage group (P0. 031), blood transfusion was found in 2 cases (8%) in no drainage group and 4 cases (16%) in drainage group, the total amount of blood loss, postoperative hospitalization days, ecchymosis and thigh diameter difference were observed in the drainage group. There was no significant difference between the two groups in dressing changing times, coagulation function of D-2 polymer after operation, the time of dropping down after operation and the time of removing thread. There was no significant difference between the two groups. No deep vein thrombosis and pulmonary embolism of lower extremities were found after operation, and no obvious hematoma formation was found in the two groups. There was no infection between the two groups. There was no significant difference between the drainage group and the non-drainage group (P0.05). Conclusion: the primary total hip replacement via direct anterior approach can relieve the pain and obtain better hip motion, but the hemoglobin loss and blood transfusion rate are higher than those without drainage. In order to get good early curative effect after operation, it is suggested that drainage should be placed regularly after DAA-THA, and the postoperative complications can be reduced by rational use of hemostatic drugs and thrombus prevention drugs in perioperative period.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

【相似文献】