本文選題：全髖關(guān)節(jié)置換術(shù)　切入點(diǎn)：引流　出處：《華北理工大學(xué)》2017年碩士論文

【摘要】：目的人工全髖關(guān)節(jié)置換術(shù)(THA)在臨床應(yīng)用越來(lái)越普遍,已經(jīng)成為治療終末期髖關(guān)節(jié)疾患的首要選擇[1]。為了減少積液、預(yù)防血腫及感染發(fā)生,引流管系統(tǒng)被廣泛應(yīng)用于全髖關(guān)節(jié)置換術(shù)后。本研究通過(guò)對(duì)比初次全髖關(guān)節(jié)置換術(shù)后引流管在減少術(shù)后并發(fā)癥、提高患者健康質(zhì)量方面的實(shí)際臨床效果,進(jìn)而探討引流管系統(tǒng)在全髖關(guān)節(jié)置換術(shù)后存在的合理性與安全性,為術(shù)后傷口的妥善處理提供合理建議。方法篩選符合試驗(yàn)方案的唐山二院關(guān)節(jié)二科2014年4月至2015年12月初次單側(cè)全髖關(guān)節(jié)置換術(shù)病例共52髖,按隨機(jī)分組原則分為引流組和非引流組各26例。系統(tǒng)觀察比較三大項(xiàng)目指標(biāo):1包括手術(shù)前后血紅蛋白、圍手術(shù)期總失血量、血清蛋白、紅細(xì)胞比積下降值等客觀檢驗(yàn)內(nèi)容;2并發(fā)癥指征如傷口滲液、血腫、感染、雙下肢深靜脈血栓等臨床指標(biāo);3其他指標(biāo)包括輸血例數(shù)、住院花銷(去除假體費(fèi)用)、術(shù)后48h情緒評(píng)分(漢密爾頓焦慮量表即HAMA)、出院后隨訪第3、6、12個(gè)月髖關(guān)節(jié)Charnley評(píng)分等,進(jìn)行統(tǒng)計(jì)學(xué)分析有無(wú)統(tǒng)計(jì)學(xué)意義,客觀評(píng)估全髖關(guān)節(jié)置換術(shù)后傷口內(nèi)置引流管的實(shí)際臨床效果和安全性。結(jié)果1通過(guò)比較發(fā)現(xiàn)引流組血清蛋白、紅細(xì)胞比積術(shù)后下降值及輸血例數(shù)均明顯高于非引流組,引流組并發(fā)癥總體發(fā)生率高于非引流組,非引流組患者的住院花銷少于引流組,組內(nèi)比較兩組患者術(shù)后1年髖關(guān)節(jié)Charnley評(píng)分較出院3個(gè)月時(shí)提升幅度較大,引流組情緒焦慮評(píng)分較術(shù)前增長(zhǎng)值明顯高于非引流組,這些指標(biāo)均具有統(tǒng)計(jì)學(xué)意義(P0.05)。2全髖關(guān)節(jié)置換術(shù)后可能與傷口放置引流管有關(guān)的并發(fā)癥如傷口滲液、血腫、感染及雙下肢深靜脈血栓等發(fā)生率的統(tǒng)計(jì),引流組個(gè)別指標(biāo)偏高,但組間差異不明顯。引流組和非引流組在總失血量及48h術(shù)后血紅蛋白比較無(wú)特質(zhì)性差異,術(shù)后三次隨訪(3、6、12月)進(jìn)行的兩組間Charnley評(píng)分差異不顯著,無(wú)統(tǒng)計(jì)意義(P0.05)。結(jié)論初次全髖關(guān)節(jié)置換術(shù)后傷口內(nèi)置引流管不能減少術(shù)后并發(fā)癥,相反會(huì)增加出血傾向、輸血率及住院總花銷,誘發(fā)患者負(fù)面情緒的產(chǎn)生;引流管的放置也不會(huì)明顯促進(jìn)患者的康復(fù)練習(xí)及髖關(guān)節(jié)功能恢復(fù);初次全髖關(guān)節(jié)置換術(shù)后傷口內(nèi)置引流管意義不大,傷口需要進(jìn)一步妥善處理。
[Abstract]:The purpose of total hip arthroplasty (THA) in clinical application is more and more common, has become the first choice for treatment of [1]. in end-stage hip disease, in order to reduce the effusion, hematoma and infection prevention, drainage system is widely used in total hip arthroplasty. The study by comparing the primary total hip arthroplasty postoperative drainage tube complications in reducing postoperative actual clinical effect to improve the health quality of the patients, and to explore the feasibility and safety of existing in the total hip arthroplasty postoperative drainage tube system, provide reasonable suggestions for proper treatment of postoperative wound. Methods of screening the second hospital of Tangshan from April 2014 to December 2015 two joint primary unilateral total hip arthroplasty with the test cases for a total of 52 hips were randomly divided into drainage group and non drainage group with 26 cases in each group. To observe and compare the three item index system including surgery: 1 Before and after the hemoglobin, total perioperative blood loss, serum protein, red blood cells decreased value of objective test content than the product; 2 complications indications such as wound exudate, hematoma, infection, lower extremity deep vein thrombosis and other clinical indicators; 3 other indicators include the number of blood transfusion, hospitalization expenses (removal expenses, postoperative prosthesis) 48h scores (Hamilton anxiety scale, HAMA) after discharge in 3,6,12 months follow-up Charnley hip score, were analyzed statistically, wound drainage actual clinical efficacy and safety of the objective evaluation after total hip replacement. The 1 is found by comparing the drainage group serum protein, red blood cell decline in value and the number of blood transfusion were significantly higher than in non drainage group than the product after the operation, complications of overall drainage group incidence was higher than that of non drainage group and non drainage group hospitalization costs less than the drainage group, compared two groups of patients 1 years after the Charnley hip score was discharged 3 months to improve greatly, the drainage group anxiety score was significantly higher than the growth in non drainage group, these indexes were statistically significant (P0.05.2) after total hip arthroplasty and wound drainage related complications such as wound exudate, hematoma. Statistics and double infection of lower extremity deep venous thrombosis incidence, drainage group, individual index is high, but no significant difference between the groups. The drainage group and non drainage group in total blood loss and postoperative hemoglobin 48h no trait differences, after three times of follow-up (3,6,12 months) between the two groups of Charnley score difference no significant, no statistical significance (P0.05). Conclusion in the wound after total hip arthroplasty can reduce the postoperative complications of the drainage tube, instead of increased bleeding tendency, blood transfusion rate and total hospitalization expenses, patients induced negative emotions; The placement of drainage tube will not significantly promote the rehabilitation exercises and hip function recovery of patients. After initial total hip arthroplasty, the wound drainage tube is of little significance, and the wound needs further treatment.

【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4

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