本文選題：膝關(guān)節(jié) + 關(guān)節(jié)成形術(shù)��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：隨著我國經(jīng)濟(jì)的不斷發(fā)展,人民生活水平較以前明顯提高,我國人口老齡化問題越來越重,受膝關(guān)節(jié)骨關(guān)節(jié)炎疾病困擾的患者越來越多。膝關(guān)節(jié)骨關(guān)節(jié)炎嚴(yán)重影響了人們的生活質(zhì)量。但人們對生活質(zhì)量的要求卻越來越高。于是越來越多的人選擇了人工膝關(guān)節(jié)表面置換手術(shù)治療。如今,人工假體材料更新?lián)Q代,假體設(shè)計(jì)更趨于合理,假體使用壽命越來越長。TKA手術(shù)具備有效緩解膝關(guān)節(jié)疼痛,良好的膝蓋功能重建等優(yōu)點(diǎn),已成為膝關(guān)節(jié)骨關(guān)節(jié)炎的首選治療方法。但TKA術(shù)后截骨骨創(chuàng)面和髓腔內(nèi)出血量大,有些患者手術(shù)之后不得不同種異體輸血。但臨床用血血源緊張,患者和臨床醫(yī)生飽受同種異體輸血窗口時(shí)期感染疾病的困擾。一種減少手術(shù)創(chuàng)傷引起的出血的新方法,降低術(shù)后輸血的風(fēng)險(xiǎn)及相應(yīng)的損失的新方法應(yīng)運(yùn)而生。目前國內(nèi)外有很多報(bào)道在TKA術(shù)中靜脈或局部使用氨甲環(huán)酸可以減少術(shù)后失血。但目前對于怎樣使用氨甲酸可以達(dá)到最好的效果,沒有統(tǒng)一的意見。氨甲環(huán)酸使用局部關(guān)節(jié)腔和使用靜脈注射效果也有很大的爭議。無論在國內(nèi)還是國外有很多相關(guān)的研究和報(bào)告,但沒有統(tǒng)一的結(jié)論。局部使用氨甲環(huán)酸應(yīng)在手術(shù)操作結(jié)束后將引流管夾閉一段時(shí)間,其目的是增加局部氨甲環(huán)酸的濃度,藥物效果發(fā)揮到最大。所以本研究術(shù)后夾閉引流管4小時(shí),使氨甲環(huán)酸作用時(shí)間盡量延長,以發(fā)揮最大效果。目的:探討膝關(guān)節(jié)腔局部應(yīng)用氨甲環(huán)酸對初次膝關(guān)節(jié)表面置換術(shù)后失血量及并發(fā)癥發(fā)生率的影響。方法:利用河北醫(yī)科大學(xué)第三醫(yī)院病案系統(tǒng)收集2014年8月~2014年12月于我科室行單側(cè)人工膝關(guān)節(jié)表面置換術(shù)并適用于后交叉韌帶保留型骨水泥固定人工膝關(guān)節(jié)假體(德國Link公司),由同一位資深關(guān)節(jié)外科專家主刀的人工膝關(guān)節(jié)表面置換術(shù)病例,依照納入、排除標(biāo)準(zhǔn)一一進(jìn)行篩選。共104例患者納入試驗(yàn),根據(jù)是否使用氨甲環(huán)酸分成使用氨甲環(huán)酸(15mg/kg)組為A組和未使用氨甲環(huán)酸組為B組。止血帶充氣后采用膝關(guān)節(jié)前正中縱行切口,髕旁內(nèi)側(cè)入路進(jìn)入關(guān)節(jié)腔,完成膝關(guān)節(jié)股骨、脛骨截骨,髕骨均不置換。安裝膝關(guān)節(jié)人工假體試模,活動(dòng)膝關(guān)節(jié)以測試活動(dòng)度及穩(wěn)定性。然后拆除試模,沖洗截骨面,安裝骨水泥型假體。A組在放置引流管縫合關(guān)節(jié)囊松止血帶前5分鐘由引流管向膝關(guān)節(jié)腔內(nèi)注入稀釋后到的20毫升0.9%氯化鈉注射液的氨甲環(huán)酸(15 mg/kg),B組放置引流后注入等量生理鹽水。松止血帶后嚴(yán)密止血,關(guān)節(jié)腔內(nèi)放置引流管,逐層縫合術(shù)區(qū)切口,患肢加壓包扎。術(shù)后兩組均夾閉引流管4小時(shí)。分析比較兩組性別、年齡、病程、術(shù)中出血量、術(shù)后引流量、術(shù)后總失血量、隱性出血量、術(shù)后血紅蛋白含量、術(shù)后紅細(xì)胞比容、術(shù)后并發(fā)癥等因素,術(shù)后第4天行下肢深靜脈超聲查有無深靜脈血栓形成。結(jié)果:兩組患者性別、年齡、病程、體重指數(shù)、術(shù)前D-二聚體比較無統(tǒng)計(jì)學(xué)差異(P0.05)。兩組術(shù)中失血量、術(shù)后第2天D-二聚體比較,P0.05,無統(tǒng)計(jì)學(xué)差異;A組術(shù)后24 h引流量、總引流量、總失血量、隱性失血量均明顯低于B組,兩組比較P0.05,差異有統(tǒng)計(jì)學(xué)意義;術(shù)后第2天A組紅細(xì)胞比容、血紅蛋白含量明顯高于B組,兩組比較P0.05,差異有統(tǒng)計(jì)學(xué)意義(見表2)。術(shù)后A組和B組分別有7例(13%)和12例(37%)患者輸血,組間比較P0.05,差異有統(tǒng)計(jì)學(xué)意義。下肢深靜脈血栓發(fā)生率兩組比較P0.05,差異無統(tǒng)計(jì)學(xué)意義。兩組均無發(fā)生肺栓塞病例。結(jié)論:在初次人工膝關(guān)節(jié)表面置換術(shù)中關(guān)節(jié)內(nèi)應(yīng)用氨甲環(huán)酸可以顯著減少術(shù)后失血量,降低輸血率及輸血量,且不增加血栓栓塞以及術(shù)后感染等并發(fā)癥的發(fā)生率。
[Abstract]:With the continuous development of our country's economy, the living standard of the people has been greatly improved. The problem of population aging is becoming more and more serious in our country. More and more patients are suffering from osteoarthritis of the knee joint. Osteoarthritis of the knee has seriously affected the quality of life of the people. But the demands for the quality of life are getting higher and higher. People choose artificial knee joint surface replacement surgery. Nowadays, prosthesis material is updated, prosthesis is more reasonable, and the life of prosthesis is longer and longer..TKA operation has the advantages of effective relief of knee joint pain and good knee function reconstruction, and it has become the first choice for osteoarthritis of knee joint. But after TKA operation, it is the first choice for the treatment of osteoarthritis of the knee. Some patients have to be allogeneic blood transfusion after surgery. However, the patients and clinicians are plagued by the disease in the period of the allogeneic transfusion window. A new method of reducing the bleeding caused by surgical trauma, reducing the risk of postoperative blood transfusion and the corresponding loss of blood transfusion, is a new method for the patients and clinicians. At present, there are many reports that intravenous or local use of methicocyclic acid in TKA can reduce postoperative bleeding. However, there is no unified opinion on how to use carbamate to achieve the best effect. There is also a lot of controversy over the use of local articular cavity and intravenous injection. There are many related studies and reports abroad, but there is no unified conclusion. The local use of methicocyclic acid should be closed for a period of time after the operation. The aim is to increase the concentration of local methicate, and the effect of the drug is maximum. Therefore, after the operation, the drainage tube is closed for 4 hours to make methicate action. Purpose: To explore the effect of the local application of methicyclic acid on the loss of blood and the incidence of complications after primary knee replacement in the knee joint cavity. Methods: using the medical record system of the Third Hospital of Hebei Medical University to collect the unilateral knee arthroplasty in our department in December ~2014 August 2014. A total of 104 cases of artificial knee joint prosthesis with retained posterior cruciate ligament (Link company, Germany), which was selected by the same senior joint surgeon, were selected for the replacement of the knee joint surface replacement. A total of 104 patients were included in the trial to divide the use of methicate into the use of methicyclic acid. (15mg/kg) group A and unused methicinic acid group as group B. After the tourniquet was inflated, the knee joint anterior medial longitudinal incision was adopted, and the medial paracellar approach entered the joint cavity. The knee joint femur, tibial osteotomy, and patella were not replaced. The knee joint prosthesis was installed to test the activity and stability of the knee joint. Then the test model was dismantled, and the test model was dismantled and washed. The bone cement type.A group was fitted with a cement type prosthesis in group.A, 5 minutes before placing the drainage tube suture suture tourniquet to the knee joint. After the drainage tube was injected into the knee joint, the 20 milliliter of Sodium Chloride Injection's methiculic acid (15 mg/kg) was injected into the knee joint, and the group B was placed and injected into the same amount of saline after drainage. Flow tube, layer by layer suture area incision, pressure bandage of affected limb. Two groups were clamp drainage tube for 4 hours after operation. The sex, age, course of disease, intraoperative bleeding, postoperative flow rate, postoperative total bleeding, recessive haemorrhage, postoperative hemoglobin content, hematocrit after operation, postoperative complications and other factors were analyzed and compared in two groups. The deep veins of lower limbs were performed on fourth days after operation. The results showed that there was no significant difference in sex, age, course of disease, body mass index, D- two polymer in the two groups (P0.05). There was no significant difference in the amount of blood loss in the two groups, the second days after the operation, D- two polymer, P0.05, and there was no statistical difference between the two groups. The volume of the total bleeding, the total loss of blood and the recessive blood loss were significantly lower than that of B after operation in group A. Group, two groups compared P0.05, the difference was statistically significant, second days after the operation, group A erythrocyte specific volume, hemoglobin content was significantly higher than the B group, two groups of P0.05, the difference was statistically significant (see Table 2), 7 cases (13%) and 12 (37%) patients in group A and B, respectively, P0.05, the difference was statistically significant. Lower extremity deep vein thrombosis. There was no significant difference in the rate of P0.05 in the two groups. There was no pulmonary embolism in the two groups. Conclusion: the application of methicyclic acid during the initial artificial knee replacement surgery can significantly reduce the amount of blood loss, reduce the rate of blood transfusion and blood transfusion, and do not increase the incidence of complications such as thromboembolism and postoperative infection.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4

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