【摘要】：背景:減少手術(shù)失血在一定程度上可以預(yù)防人工膝關(guān)節(jié)置換的并發(fā)癥,可以減輕術(shù)后患肢腫脹和不適,有利于患者術(shù)后康復(fù)。目的:探討減少人工膝關(guān)節(jié)置換失血的方法。方法:將單側(cè)初次人工膝關(guān)節(jié)置換的患者分為2組。對照組(27例)采用傳統(tǒng)的手術(shù)方法,全程使用止血帶,并留置引流管;實驗組(36例)對手術(shù)方法進(jìn)行改良,只有在安裝假體時使用止血帶,對軟組織出血予以充分止血,縫合關(guān)節(jié)囊后在關(guān)節(jié)腔內(nèi)注射止血藥液,置換后不留置引流管。比較2組患者的術(shù)前、置換后血紅蛋白、置換后血紅蛋白的下降值、膝關(guān)節(jié)疼痛評分、關(guān)節(jié)活動度、輸血率、傷口愈合情況等臨床結(jié)果。結(jié)果與結(jié)論:(1)兩組患者關(guān)節(jié)置換前血紅蛋白差異無顯著性意義,置換后第1,4,7天對照組血紅蛋白均顯著低于實驗組,而且對照組血紅蛋白跟置換前相比的下降值均顯著高于實驗組;(2)兩組的膝關(guān)節(jié)疼痛評分差異無顯著性意義;(3)置換后第7天實驗組膝關(guān)節(jié)活動度顯著大于對照組。(4)對照組置換后輸血率為18.5%,1例患者傷口愈合不良;實驗組置換后沒有患者需要輸血,所有患者傷口均正常愈合。(5)兩組患者均未出現(xiàn)置換后感染、血腫形成等并發(fā)癥。(6)結(jié)果說明,通過改良手術(shù)方法,可以減少人工膝關(guān)節(jié)置換術(shù)的失血量,避免膝關(guān)節(jié)置換后輸血,有助于置換后康復(fù)。
[Abstract]:Background: to a certain extent, reducing blood loss can prevent the complications of artificial knee arthroplasty, alleviate the swelling and discomfort of the affected limbs, and is beneficial to the postoperative rehabilitation of the patients. Objective: to study the method of reducing blood loss in artificial knee arthroplasty. Methods: the patients were divided into two groups. In the control group (27 cases), the traditional operative method was used, tourniquet was used in the whole process, and the drainage tube was retained. In the experimental group (36 cases), the operative method was improved, only when the prosthesis was installed, the tourniquet was used to fully stop the bleeding of soft tissue. After the joint capsule was sutured, the hemostatic fluid was injected into the articular cavity, and the drainage tube was not retained after replacement. The clinical results of the two groups were compared, such as the decrease of hemoglobin before and after replacement, knee joint pain score, joint motion, blood transfusion rate, wound healing and so on. Results and conclusion: (1) there was no significant difference in hemoglobin before joint replacement between the two groups. The hemoglobin in the control group was significantly lower than that in the experimental group on the 7th day after arthroplasty. The decrease of hemoglobin in the control group was significantly higher than that in the experimental group; (2) there was no significant difference in knee pain score between the two groups; (3) the knee joint motion in the experimental group was significantly higher than that in the control group on the 7th day after replacement. In the control group, the rate of blood transfusion after replacement was 18.5% and 1 patient had poor wound healing. No patients in the experimental group needed blood transfusion and all the wounds healed normally. (5) there were no complications such as infection, hematoma formation and other complications in the two groups. (6) the results showed that, through the modified surgical method, no complications such as infection and hematoma formation were found in the two groups. It can reduce blood loss after knee arthroplasty, avoid blood transfusion after knee arthroplasty, and be helpful to rehabilitation after knee arthroplasty.
【作者單位】： 江蘇省蘇北人民醫(yī)院關(guān)節(jié)外科揚(yáng)州大學(xué)臨床醫(yī)學(xué)院;
【基金】：國家自然科學(xué)基金資助項目(81501870)~~
【分類號】：R687.4;R318.17

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