本文選題：膝骨性關(guān)節(jié)炎 + 膝關(guān)節(jié)表面置換術(shù)��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:探討膝關(guān)節(jié)表面置換術(shù)后患肢屈膝位和伸直位對(duì)圍手術(shù)期失血量的影響,以期為臨床工作提供幫助和指導(dǎo)。方法:選擇2015年1月—2016年6月在我院實(shí)施的初次單側(cè)TKA手術(shù)的骨性關(guān)節(jié)炎患者60名納入研究中,隨機(jī)分為實(shí)驗(yàn)組、對(duì)照組等2組。實(shí)驗(yàn)組為A組(30名,男性患者7名,女性患者23名,其中行左側(cè)手術(shù)18名,行右側(cè)手術(shù)12名,平均年齡64歲):術(shù)后用特定角度制作下肢墊使患肢屈髖大腿抬氋45°,屈膝60°6h;對(duì)照組為B組(30例,男性患者6名,女性患者24名,其中行左側(cè)手術(shù)19名,行右側(cè)手術(shù)11名,平均年齡67歲):患肢術(shù)后髖、膝關(guān)節(jié)伸直位。記錄全部患者基本身體信息。登記術(shù)前、術(shù)后24h紅細(xì)胞比容值、計(jì)算并登記術(shù)中出血量、術(shù)后24h切口引流量和異體血輸注量,同時(shí)記錄所有患者住院天數(shù)和術(shù)后第5天膝關(guān)節(jié)活動(dòng)度,仔細(xì)觀察手術(shù)切口有無(wú)裂開、有無(wú)膿性分泌物及注意切口愈合情況,術(shù)后7天所有患者行下肢血管彩色多普勒超聲檢查明確是否存在血栓的形成。結(jié)果:1.兩組患者基本身體狀況信息及手術(shù)肢體側(cè)無(wú)統(tǒng)計(jì)學(xué)差異;術(shù)前常規(guī)化驗(yàn)如24h紅細(xì)胞壓積Hct也無(wú)明顯統(tǒng)計(jì)學(xué)差異。2.術(shù)后住院天數(shù)無(wú)明顯差異,分別為13.3天和13.4天,p=0.9;術(shù)后第5天兩組膝關(guān)節(jié)活動(dòng)度無(wú)統(tǒng)計(jì)學(xué)差異,分別為113°和117°,p=0.13;兩組患者均無(wú)切口愈合不良及感染發(fā)生;兩組患者術(shù)后7天各出現(xiàn)1例下肢深靜脈血栓形成患者;術(shù)中出血量無(wú)差異,分別為206ml和210ml,p=0.84。3.術(shù)后24h實(shí)驗(yàn)組及對(duì)照組切口引流量有統(tǒng)計(jì)學(xué)差異,分別為172ml和272ml,p=0.030.05;實(shí)驗(yàn)組及對(duì)照組計(jì)算總失血量有統(tǒng)計(jì)學(xué)差異,分別為803ml和1059ml,p=0.0030.05;實(shí)驗(yàn)組及對(duì)照組根據(jù)GROSS方程計(jì)算隱性失血有統(tǒng)計(jì)學(xué)差異,分別是428ml和576ml,p=0.0340.05。結(jié)論:TKA術(shù)后保持患肢屈髖大腿舉氋45°、屈膝60°6h與患肢伸直位比較可以降低術(shù)后總失血量、引流量及隱性失血量,同時(shí)并不增加患者住院時(shí)間、并發(fā)癥發(fā)生率及影響患肢功能,所以TKA術(shù)后采用該體位是一個(gè)簡(jiǎn)便可行、安全有效降低術(shù)后失血的方式,可考慮試推廣于臨床。
[Abstract]:Objective: to investigate the effect of knee flexion and extension position on perioperative blood loss after knee surface replacement in order to provide help and guidance for clinical work. Methods: from January 2015 to June 2016, 60 patients with osteoarthritis undergoing primary unilateral TKA operation in our hospital were randomly divided into two groups: experimental group and control group. The experimental group consisted of 30 patients in group A, 7 males and 23 females. Among them, 18 were operated on the left side and 12 on the right. The average age was 64 years old: after operation, the lower extremity pad was made with a specific angle for 45 擄of flexion of hip and thigh and 60 擄6 h of knee flexion in the affected extremities, while the control group consisted of 30 cases in group B, 6 males and 24 females, of which 19 underwent left operation and 11 underwent right operation. Mean age 67 years: hip and knee extension after operation. Record basic body information of all patients. The specific volume of erythrocyte was recorded before and 24 hours after operation, the amount of intraoperative bleeding was calculated and registered, the incision drainage volume and the volume of allogeneic blood transfusion were recorded at the same time, the days of hospitalization and the knee joint movement on the 5th day after operation were recorded. After 7 days of operation, all the patients were examined by color Doppler ultrasound to determine whether there was thrombosis or not. The result is 1: 1. There was no significant difference between the two groups in the basic physical condition information and the limb side of the operation, and there was no significant difference between the two groups in preoperative routine tests such as 24h hematocrit Hct. 2. There was no significant difference in postoperative hospitalization days (13.3 days and 13.4 days) between the two groups, and there was no significant difference in knee joint motion between the two groups on the 5th day after operation (113 擄and 117 擄/ 0.13 respectively). There was no difference in the amount of blood loss between the two groups (206ml and 210ml) on the 7th day after operation. 24 hours after operation, there were significant differences in incision drainage volume between the experimental group and the control group (172ml and 272 ml) 0.030.05.The total blood loss in the experimental group and the control group was significantly different from that in the control group. There were significant differences in the recessive blood loss between the experimental group and the control group according to the GROSS equation, 428ml and 576 ml, respectively. Conclusion keeping flexion hip and thigh lift 45 擄and flexion knee 60 擄6 h after 1: TKA can reduce the total blood loss, drainage volume and recessive blood loss, and does not increase the hospital stay, the incidence of complications and affect the function of the affected limb, compared with the extension position of the affected limb. Therefore, it is simple and feasible to adopt this position after TKA, and it is safe and effective to reduce postoperative blood loss.
【學(xué)位授予單位】：吉林大學(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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