TKA术后早期局部症状群规律探究

发布时间：2019-02-25 09:08

【摘要】：目的本研究通过前瞻性观察全膝关节置换术(TKA)后患肢早期局部症状群,总结症状群所呈现的规律特征,探究症状群之间的相互关系,为临床更好地防治TKA术后局部并发症提供参考依据。方法本研究以手术时间为准,收集2014年1月到2014年12月在广东省中医院骨三科行全膝关节置换术的患者,观察TKA术前1天、术后第2、4、7、14天患肢肿胀程度、疼痛程度、疼痛区域、瘀斑区域、麻木区域、双膝皮温变化,初步总结出TKA术后早期局部症状群规律。结果本研究共收集我科晚期膝骨性关节炎患者124例,其中7例患者采取分期行双膝关节置换术,手术例数共131例。男性18例,占14.5%,女性106例,占85.5%。在124例TKA患者中,以55-75岁患者为主,共有90例,占72.5%,55岁以下的患者共4例,占3.4%,而75岁以上的患者共30例,占24.1%。BMI肥胖者占73.4%,正常者占26.6%。肿胀程度变化、疼痛程度变化、皮温变化根据观察时点各自采用重复测量方差分析,结果显示有统计学意义(P0.05)。观察结果显示：术后2天疼痛较术前缓解、术后4天疼痛少许加重,术后7天疼痛达到峰值,之后开始回落,到术后14天疼痛明显减轻。不同观察时点疼痛集中区域各异。肿胀从术后开始出现并不断增加,到术后4天肿胀达到峰值,后逐渐减退直至恢复正常。不同观察时点瘀斑集中区域各异。每位患者术后各时点麻木出现部位相一致,主要集中在外下区,但患者之间的麻木集中区域仍有少许差异。术后患者双膝关节皮温均升高,术后2天双膝皮温达到峰值,但患侧皮温升高幅度更大,之后均逐渐回落。术后肿胀程度、疼痛程度、皮温之间采用Pearson相关系数分析,结果显示存在正相关性,其中肿胀与皮温相关性最强。结论TKA术后患肢早期局部症状群各自呈现出一定的规律特征,且症状之间存在相互联系,以致出现不同症状的相互组合,形成不同的症状群特征。因此,初步总结出TKA术后局部症状群的变化规律,为今后进一步地提高手术技术以及做好TKA术后的防治工作提供了重要参考。
[Abstract]:Objective to observe the early local symptom groups of the affected limbs after total knee arthroplasty (TKA), summarize the regular characteristics of the symptom groups, and explore the relationship between the symptom groups. To provide reference for clinical better prevention and treatment of local complications after TKA. Methods from January 2014 to December 2014, total knee arthroplasty was performed in the department of bone of Guangdong Provincial Hospital of traditional Chinese Medicine. The degree of limb swelling and pain were observed 1 day before TKA and 714 days after operation. The changes of pain, ecchymosis, numbness and knee skin temperature were summarized. Results 124 cases of advanced knee osteoarthritis were collected in this study. Among them, 7 cases were treated with double knee arthroplasty by stages, 131 cases were operated. There were 18 males (14.5%) and 106 females (85.5%). Of the 124 patients with TKA, 90 were aged 55-75, accounting for 4 patients under 55 years of age (3.4%), while 30 cases were over 75 years old, accounting for 73.4% of 24.1%.BMI obesity. The normal rate was 26.6%. The changes of swelling degree, pain degree and skin temperature were analyzed by repeated measurement variance according to the observed time points. The results showed that there was statistical significance (P0.05). The results showed that the pain was relieved at 2 days after operation, slightly aggravated at 4 days after operation, reached the peak at 7 days after operation, then began to fall back, and obviously relieved at 14 days after operation. Pain concentration areas vary at different observation points. The swelling began to appear and increase, reached the peak at 4 days after operation, then gradually decreased until it returned to normal. The concentration of ecchymosis was different in different observation time. Each patient had the same numbness at each time point after operation, mainly concentrated in the inferior area, but there was still a little difference in the numbness area between the patients. After operation, the skin temperature of both knees increased, and reached the peak on the 2nd day after operation, but the range of the skin temperature on the affected side increased more, and then decreased gradually. The degree of swelling, the degree of pain and the skin temperature were analyzed by Pearson correlation coefficient. The results showed that there was a positive correlation between swelling and skin temperature, and the correlation between swelling and skin temperature was the strongest. Conclusion the early local symptom groups of the affected limbs after TKA have their own regular characteristics, and the symptoms are related to each other, resulting in different symptom combinations and forming different symptom groups. Therefore, the change rule of local symptom group after TKA is summarized, which provides an important reference for further improving the operation technique and doing well the prevention and treatment of TKA.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

【参考文献】