本文選題：骨關(guān)節(jié)炎 + 全膝關(guān)節(jié)置換術(shù)　； 參考：《浙江大學(xué)》2015年博士論文

【摘要】：研究目的：研究全膝關(guān)節(jié)置換術(shù)中全程和前半程使用止血帶對患者術(shù)后早期康復(fù)效果的影響。 研究方法：選擇2014年6月1日至2015年1月31日于浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院入院和出院主診斷均為左(或右)膝骨關(guān)節(jié)炎,并且初次行全膝關(guān)節(jié)置換術(shù),術(shù)中分別為全程和前半程使用止血帶的患者各40名,依據(jù)住院病歷系統(tǒng)的資料進(jìn)行回顧性研究。對兩組患者的手術(shù)時間,術(shù)中失血量、圍手術(shù)期輸血率、材料費(fèi)用、術(shù)后住院時間、實(shí)驗(yàn)室檢查、紅細(xì)胞丟失量以及術(shù)后嚴(yán)重并發(fā)癥的發(fā)生率等系列指標(biāo)進(jìn)行對比分析。 研究結(jié)果：與全程使用止血帶相比,前半程組的劣勢主要有延長手術(shù)時間(68.68±10.73v.s.87.65±11.45min;P0.001),也增加了術(shù)中失血量(97.88±39.89v.s.127.50±49.29mL;P=0.004).它的優(yōu)勢主要有減少總紅細(xì)胞丟失量(53.73±147.38v.s.344.51±125.88mL；P=0.017)和隱性紅細(xì)胞丟失量(310.40±137.68v.s.215.13±119.31mL;P=0.025),縮短了術(shù)后住院時間(9.60±3.42v.s.7.05±2.89天；P=0.001),并且患者術(shù)后下肢關(guān)節(jié)功能恢復(fù)器的輔助彎曲角度可以更快達(dá)到90。(4.74±1.69v.s.4.00±1.11天；P=0.028)。兩組患者在圍手術(shù)期輸血率、顯性紅細(xì)胞丟失量上無顯著性差異。 研究結(jié)論：全膝關(guān)節(jié)置換術(shù)中止血帶的應(yīng)用已經(jīng)被眾多關(guān)節(jié)外科醫(yī)生所接受,在創(chuàng)口縫合之前釋放止血帶進(jìn)行止血,不僅能減少患者圍手術(shù)期失血量,還縮短住院時間,有利于患者早期功能鍛煉,同時不會增加血管栓塞及術(shù)后嚴(yán)重感染等并發(fā)癥的發(fā)生率。
[Abstract]:Objective: to study the effect of tourniquet on early postoperative rehabilitation after total knee arthroplasty. Methods: from June 1, 2014 to January 31, 2015, the main diagnosis of left (or right) knee osteoarthritis was performed at the second affiliated Hospital of Zhejiang University School of Medicine, and total knee arthroplasty was performed for the first time. A retrospective study was carried out in 40 patients using tourniquet during the whole and the first half of the operation, respectively, according to the data of the inpatient medical record system. The operation time, intraoperative blood loss, perioperative blood transfusion rate, material cost, postoperative hospitalization time, laboratory examination, red blood cell loss and the incidence of severe postoperative complications were compared and analyzed between the two groups. Results: compared with the whole course of tourniquet use, the main disadvantages of the first half group were to prolong the operation time (68.68 鹵11.45min) P0.001a, and to increase the blood loss during operation (97.88 鹵49.29mL / P 0.004). The main advantages were to reduce the total RBC loss (53.73 鹵125.88mLP0.017) and occult RBC loss (310.40 鹵119.31mLP0. 025), which shortened the postoperative hospitalization time (9.60 鹵3.42v.s.7.05 鹵2.89 days), and the auxiliary bending angle of the lower limb joint function restorer could reach 90.0.4.74 鹵1.11 days P0.028. There was no significant difference in blood transfusion rate and dominant red blood cell loss between the two groups during perioperative period. Conclusion: the application of tourniquet in total knee arthroplasty has been accepted by many joint surgeons. The release of tourniquet before suture of the wound can not only reduce the amount of blood loss in perioperative period, but also shorten the length of hospital stay. It is beneficial to early functional exercise and does not increase the incidence of complications such as vascular embolism and severe postoperative infection.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R687.4

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相關(guān)期刊論文 前1條

1 李軍;荊玨華;;止血帶對全膝關(guān)節(jié)置換術(shù)失血量和軟組織損傷的影響:一項(xiàng)隨機(jī)對照研究[J];臨床骨科雜志;2013年01期

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本文編號：1872792