本文選題：止血帶 + 全膝關(guān)節(jié)置換術(shù)��； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的：是討論止血帶的不同使用方法對初次全膝關(guān)節(jié)置換(TKAtotal knee arthroplasty)術(shù)后臨床效果的比較，為TKA中止血帶的使用方法的選擇提供一定的參考依據(jù)和臨床數(shù)據(jù)。 方法：采用回顧性分析2013年8月--2014年11月吉林大學(xué)第三臨床醫(yī)院骨科11樓首次行TKA手術(shù)的患者資料。選擇符合本文研究標(biāo)準(zhǔn)的80例膝關(guān)節(jié)骨性關(guān)節(jié)炎的病人,這些病人隨機(jī)分為兩組，其中A組40例病人手術(shù)開始時(shí)就使用止血帶,而B組40例病人是在脛骨或股骨準(zhǔn)備截骨時(shí)才開始使用止血帶。統(tǒng)計(jì)數(shù)據(jù)中兩組符合納入標(biāo)準(zhǔn)的病人的體重指數(shù)、術(shù)前的血紅蛋白(Hb)含量、紅細(xì)胞計(jì)數(shù)（RBC）、紅細(xì)胞比容（Hct）、疼痛視覺模擬評分(VAS)、關(guān)節(jié)活動度差別沒有統(tǒng)計(jì)學(xué)意義（P0.05)詳見表（1-4）。比較兩組病人術(shù)后24h的RBC、Hct、Hb含量及術(shù)后下肢靜脈血栓形成情況(發(fā)生率)、隱性失血量、顯性失血量及總的失血量,兩組輸血率及術(shù)后3d及術(shù)后7d的VAS評分評分，以及術(shù)后3d，術(shù)后7d，術(shù)后3月患側(cè)膝關(guān)節(jié)的活動度。并以SPSS17.0軟件做相關(guān)統(tǒng)計(jì)分析,其中連續(xù)型變量采用t檢驗(yàn),分類變量采用x2檢驗(yàn),計(jì)算出對應(yīng)的統(tǒng)計(jì)量和P值。P＜0.05認(rèn)為組間有統(tǒng)計(jì)意義，p0.05認(rèn)為組間沒有統(tǒng)計(jì)學(xué)意義。 結(jié)果：術(shù)后24h內(nèi),兩組患者Hb及Hct及RBC比較,結(jié)果都沒有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組總的失血量比較結(jié)果沒有統(tǒng)計(jì)學(xué)意義(F=0.398,P=0.5320.05); A組（手術(shù)開始時(shí)應(yīng)用止血帶組）顯性失血量少于B（準(zhǔn)備截骨時(shí)應(yīng)用止血帶組）組（P=0.0130.05）,但隱性失血量要多于B組(P=0.0270.05),結(jié)果有統(tǒng)計(jì)學(xué)意義。術(shù)后3dB組關(guān)節(jié)活動度優(yōu)于A組（F=8.312，P=0.0160.05），，術(shù)后5、7d及術(shù)后3個(gè)月時(shí)兩組關(guān)節(jié)活動度比較結(jié)果無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后A組中10例(25%)、B組中8例(20%)應(yīng)用自體血或異體血回輸治療,其中A組與B組輸血率比較行統(tǒng)計(jì)學(xué)分析(X2=0.287,P=0.7900.05)結(jié)果無意義(見表5)。病人手術(shù)切口都為I級甲等級愈合。B組術(shù)后3天VAS評分優(yōu)于A組（P=0.0060.05）,術(shù)后7天的VAS評分差別無統(tǒng)計(jì)學(xué)意義(P=0.9140.05)。術(shù)后行膝關(guān)節(jié)正側(cè)位檢查示,假體未見明顯異常。術(shù)后血栓發(fā)生率A組4例（均為小腿肌間靜脈血栓），B組3例（也為肌間靜脈血栓），兩組均無急性肺栓塞發(fā)生，下肢靜脈血栓發(fā)生率（，P=0.9050.05)結(jié)果無統(tǒng)計(jì)學(xué)意義（詳見表6） 結(jié)論：全膝關(guān)節(jié)置換手術(shù)中全程使用止血帶與截骨時(shí)使用止血帶相比并沒有減少自體或異體血的回輸，雖然減少了顯性失血量，但是增加了隱性失血量，并且在總失血量上兩者差別沒有統(tǒng)計(jì)學(xué)差異，因此在對于易患有血栓的高風(fēng)險(xiǎn)患者來說筆者認(rèn)為應(yīng)該盡量縮短止血帶使用時(shí)間及壓力。
[Abstract]:Objective: to compare the clinical effects of different tourniquet use methods after TKA total knee arthroplasty (TKA total knee arthroplasty), and to provide some references and clinical data for the choice of tourniquet use methods in TKA. Methods: the data of patients undergoing TKA operation on the 11th floor of Orthopaedics Department of the third Clinical Hospital of Jilin University from August 2013 to November 2014 were retrospectively analyzed. Eighty patients with knee osteoarthritis who met the criteria of the present study were randomly divided into two groups: group A, 40 patients were treated with tourniquet at the beginning of operation, In group B, 40 patients began using tourniquet when tibia or femur was ready for osteotomy. The body mass index (BMI), preoperative hemoglobin (HB) content, erythrocyte count (RBCU), RBC specific volume (HCT), pain visual analogue score (VASA), and no significant difference in joint activity between the two groups were found in Table 1-4. The contents of hcttl HB and venous thrombosis of lower extremity (incidence rate, recessive blood loss, dominant blood loss and total blood loss) were compared between the two groups 24 hours after operation. The blood transfusion rate and the VAS score of 3 days and 7 days after operation were compared between the two groups. And 3 days after operation, 7 days after surgery, 3 months after the operation of the knee motion. SPSS17.0 software was used to do the related statistical analysis, in which the continuous variables were analyzed by t test and the classification variables by x2 test. The corresponding statistics and P < 0. 05 showed that there was statistical significance among the groups. P0. 05 thought there was no statistical significance among the groups. Results: within 24 hours after operation, there was no significant difference in HB, Hct and RBC between the two groups. There was no significant difference in total blood loss between the two groups (P < 0. 398P 0. 5320.05), but the dominant blood loss in group A (tourniquet group at the beginning of operation) was less than that in group B (using tourniquet at the time of osteotomy), but the amount of recessive blood loss was higher than that in group B (P 0. 027. 05). After operation, the range of joint motion in 3dB group was better than that in group A (8. 312%, P 0. 016 0. 05%), but there was no significant difference between the two groups at 5 days after operation and 3 months after operation (P 0. 05). There was no significant difference between group A (10 cases) and group B (8 cases (20 cases) treated with autologous or allogeneic blood transfusion. The blood transfusion rate of group A and group B were compared with that of group B (P 0.7900. 05). There was no significant difference between group A and group B (see table 5). The VAS score of group B was better than that of group A on the 3rd day after operation. There was no significant difference in VAS score between group A and group A on the 7th day after operation (P 0. 914 0. 05). Postoperative knee joint examination showed that the prosthesis was not abnormal. The incidence of postoperative thrombus in group A (3 cases in group B) (3 cases in group B (also intramuscular venous thrombosis), no acute pulmonary embolism in both groups, and the incidence of venous thrombosis in lower extremity (0.9050.05) were not statistically significant (see Table 6 for details). Conclusion: using tourniquet in the whole course of total knee arthroplasty does not decrease the amount of autologous or allogeneic blood transfusion, but it increases the amount of recessive blood loss, although it can decrease the amount of dominant blood loss, compared with the use of tourniquet during osteotomy. There was no statistical difference in the total blood loss between the two groups. Therefore, for the patients with high risk of thrombus, we think we should shorten the tourniquet usage time and pressure as far as possible.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.4

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