本文選題：季節(jié) + 關(guān)節(jié)置換　； 參考：《南京大學(xué)》2017年碩士論文

【摘要】：第一部分:不同季節(jié)關(guān)節(jié)置換術(shù)后下肢深靜脈血栓形成發(fā)生率的差異目的:探討不同季節(jié)進(jìn)行全膝關(guān)節(jié)置換或全髖關(guān)節(jié)置換術(shù)后下肢深靜脈血栓形成(deep vein thrombosis,DVT)發(fā)生率的差異。方法:采用回顧性研究方法,納入2008年8月至2016年2月共2 363例初次全膝或全髖關(guān)節(jié)置換患者,男653例,女1 710例;年齡17～91歲。術(shù)后3～5天常規(guī)行雙側(cè)下肢深靜脈造影排查血栓。按手術(shù)季節(jié)和年齡(≥65歲、65歲)進(jìn)行分組,比較不同組別患者術(shù)后DVT和癥狀性DVT發(fā)生率的差異。結(jié)果:春夏秋冬四季關(guān)節(jié)置換術(shù)后DVT的發(fā)生率分別為15.85%、14.92%、17.88%和22.50%,差異有統(tǒng)計(jì)學(xué)意義(P=0.005);春、夏、秋、冬四季全膝關(guān)節(jié)置換術(shù)后DVT發(fā)生率分別為19.09%、15.67%、18.11%和27.71%,差異有統(tǒng)計(jì)學(xué)意義(P=0.022);春、夏、秋、冬四季節(jié)全髖關(guān)節(jié)置換術(shù)后DVT發(fā)生率分別為13.48%、14.17%、17.73%和20.26%,差異有統(tǒng)計(jì)學(xué)意義(P=0.044)。春、夏、秋、冬四季關(guān)節(jié)置換術(shù)后癥狀性DVT的發(fā)生率分別為3.55%、3.78%、4.97%和 6.90%,差異有統(tǒng)計(jì)學(xué)意義(P=0.0245);春、夏、秋、冬四季全膝關(guān)節(jié)置換術(shù)后癥狀DVT的發(fā)生率分別為3.88%、4.24%、4.94%、9.64%,差異有統(tǒng)計(jì)學(xué)意義(P=0.043);春、夏、秋、冬四季全髖關(guān)節(jié)置換術(shù)后癥狀性DVT的發(fā)生率分別為3.31%、3.33%、4.99%、5.71%,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。年齡≥65歲組術(shù)后DVT的發(fā)生率在春夏秋冬四季分別為18.49%、16.61%、22.07%、28.05%,差異有統(tǒng)計(jì)學(xué)意義(P=0.002);癥狀性DVT發(fā)生率分別是4.38%、4.43%、5.72%、8.78%,差異有統(tǒng)計(jì)學(xué)意義(P=0.043)。而年齡65歲組術(shù)后DVT的發(fā)生率在春夏秋冬不同季節(jié)分別為12.46%、12.68%、11.39%、12.63%,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);癥狀性DVT發(fā)生率分別為2.49%、2.93%、3.80%、3.54%,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:不同季節(jié)關(guān)節(jié)置換術(shù)后DVT發(fā)生率不同,冬季DVT發(fā)生率最高。但季節(jié)對(duì)關(guān)節(jié)置換術(shù)后DVT的影響主要出現(xiàn)在65歲以上患者。第二部分:關(guān)節(jié)置換術(shù)后疼痛評(píng)分與下肢深靜脈血栓發(fā)生率的關(guān)系目的:探討全膝關(guān)節(jié)置換或全髖關(guān)節(jié)置換術(shù)后疼痛評(píng)分與患者深靜脈血栓(deep vein thrombosis,DVT)發(fā)生率的關(guān)系。方法:本研究采用回顧結(jié)合前瞻的方法,回顧分析2010年3月至2014年8月,共計(jì)1 445例初次單側(cè)全膝關(guān)節(jié)置換或全髖關(guān)節(jié)置換患者,所有患者均在術(shù)后3～5天行雙側(cè)下肢靜脈造影,造影前當(dāng)天早上行視覺(jué)模擬評(píng)分法(visual analogue scale,VAS)進(jìn)行評(píng)分。VAS評(píng)分范圍(0～10分,(0～3)分表示輕度疼痛,(4～10)分表示中重度疼痛。前瞻研究選自2016年2月至2016年9月的343例初次單側(cè)全膝或全髖關(guān)節(jié)置換患者。術(shù)后第1天,第3天,第7天或出院前,術(shù)后6周和術(shù)后3月時(shí)分別行彩超檢查,并對(duì)患者采用VAS疼痛評(píng)分,評(píng)分項(xiàng)目包括白天痛、夜間痛、靜息痛和活動(dòng)痛。結(jié)果:回顧分析1 445例全膝或全髖關(guān)節(jié)置換患者,男性439例,女性1 006例,平均年齡64.98 歲。其中 233 例(16.12%)DVT 患者,1 212 例(83.88%)非 DVT 患者。DVT組VAS評(píng)分3.34±1.43,非DVT組VAS評(píng)分2.97±1.29,差異具有統(tǒng)計(jì)學(xué)意義(P0.001)。輕度疼痛組900例,DVT發(fā)生率13.00%;中重度疼痛組545例,DVT發(fā)生率21.28%,差異具有統(tǒng)計(jì)學(xué)意義(P0.001)。VAS評(píng)分與血栓發(fā)生率進(jìn)行相關(guān)分析,相關(guān)系數(shù)r=0.86,P0.01。前瞻研究共計(jì)343例全膝或全髖關(guān)節(jié)置換患者。術(shù)后第1天,第3天,第7天或出院前,術(shù)后6周和術(shù)后3月的DVT組和非DVT組的白天痛、夜間痛、靜息痛和活動(dòng)痛VAS評(píng)分進(jìn)行分析,在術(shù)后第7天時(shí)DVT組和非DVT組在白天痛和活動(dòng)痛的VAS評(píng)分上有統(tǒng)計(jì)學(xué)差異(兩個(gè)P值都0.001),其它沒(méi)有統(tǒng)計(jì)學(xué)差異。分別按照白天痛、夜間痛、靜息痛和活動(dòng)痛VAS評(píng)分分為輕度疼痛組和中重度疼痛組,白天痛和活動(dòng)痛的輕度疼痛組和中重度疼痛組在術(shù)后第7天時(shí)的DVT發(fā)生率有統(tǒng)計(jì)學(xué)差異(兩個(gè)P0.05),其它組沒(méi)有統(tǒng)計(jì)學(xué)差異。結(jié)論:關(guān)節(jié)置換術(shù)后的疼痛評(píng)分與血栓發(fā)生存在很大的相關(guān)性,DVT組的疼痛評(píng)分高于非DVT組,并且中重疼痛組的DVT發(fā)生率高于輕度疼痛組。在疼痛與DVT的關(guān)系中,術(shù)后第7天的白天痛和活動(dòng)痛意義最大。
[Abstract]:Part one: differences in the incidence of deep venous thrombosis after arthroplasty in different seasons. Objective: To explore the difference in the incidence of deep venous thrombosis (deep vein thrombosis, DVT) after total knee replacement or total hip replacement in different seasons. Methods: a retrospective study was taken from August 2008 to 2 in 2016. There were 2363 cases of total knee or total hip replacement, 653 men, 1710 women, 1710 women, 17~91 years old. 3~5 days after operation, bilateral deep venous angiography was performed to check thrombus. According to the operation season and age (65 years old, 65 years old), the differences in the incidence of DVT and symptomatic DVT in different groups were compared. Results: spring, summer, autumn and winter four. The incidence of DVT after arthroplasty was 15.85%, 14.92%, 17.88% and 22.50% respectively. The difference was statistically significant (P=0.005). The incidence of DVT after total knee arthroplasty in spring, summer, autumn and winter was 19.09%, 15.67%, 18.11% and 27.71%, respectively (P=0.022); the incidence of DVT in spring, summer, autumn and winter four season after total hip arthroplasty was found. The difference was 13.48%, 14.17%, 17.73% and 20.26% respectively (P=0.044). The incidence of symptomatic DVT after arthroplasty in spring, summer, autumn and winter was 3.55%, 3.78%, 4.97% and 6.90% respectively (P=0.0245); the incidence of DVT after total knee arthroplasty in spring, summer, autumn and winter was 3.88%, 4.24%, 4.94%, respectively. 9.64%, the difference was statistically significant (P=0.043); the incidence of symptomatic DVT in spring, summer, autumn, and winter after total hip replacement was 3.31%, 3.33%, 4.99%, 5.71%, respectively (P0.05). The incidence of DVT in the group of older than 65 years old was 18.49%, 16.61%, 22.07%, 28.05%, respectively (P=0 .002); the incidence of symptomatic DVT was 4.38%, 4.43%, 5.72%, 8.78%, and the difference was statistically significant (P=0.043). The incidence of DVT in the 65 year old group was 12.46%, 12.68%, 11.39%, 12.63%, respectively (P0.05), and the incidence of symptomatic DVT was 2.49%, 2.93%, 3.80%, 3.54%, and no statistical difference. P0.05. Conclusion: the incidence of DVT after arthroplasty in different seasons is different, and the incidence of DVT in winter is the highest. But the effect of season on DVT after arthroplasty is mainly in patients over 65 years. The second part: the relationship between pain score after joint replacement and the incidence of deep venous thrombosis of lower extremity: total knee replacement or total hip arthroplasty The relationship between pain score and the incidence of deep vein thrombosis (DVT) after joint replacement. Methods: a retrospective and prospective method was used in this study to review and analyze 1445 cases of primary unilateral total knee replacement or total hip replacement from March 2010 to August 2014. All patients were performed on 3~5 days after operation. Side and lower limb venography, visual analogue scale (VAS) was performed on the same morning before the contrast (0~10 points, 0~3) for mild pain, and (4~10) to represent moderate and severe pain. Prospective study was selected from February 2016 to September 2016 for the first unilateral total knee or total hip replacement patients. Color Doppler ultrasonography was performed at first days, third days, seventh days, or before discharge, 6 weeks after operation and March after operation, and VAS pain scores were used in patients. The scores included daytime pain, nocturnal pain, resting pain and activity pain. Results: retrospective analysis of 1445 patients with total knee or total hip replacement, 439 men, 1006 women, and 64.98 years of average age. 233 Cases (16.12%) DVT patients, 1212 cases (83.88%) non DVT patients,.DVT group VAS score 3.34 + 1.43, non DVT group VAS score 2.97 + 1.29, the difference was statistically significant (P0.001). Mild pain group 900 cases, DVT incidence of 13%; moderate and severe pain group 545 cases, DVT incidence 21.28%, difference has statistical significance (P0.001).VAS score and thrombus incidence into the incidence Correlation analysis, correlation coefficient r=0.86, P0.01. prospective study total of 343 patients with total knee or total hip replacement. First days, third days, seventh days, 6 weeks after operation, 6 weeks after operation, day pain, nocturnal pain, resting pain and activity pain VAS score in group DVT and non DVT after operation, and in group DVT and non DVT group in day seventh days after operation. The VAS scores of pain and activity pain were statistically different (two P values were 0.001), and there were no other statistical differences. The VAS scores were divided into mild and moderate and severe pain groups according to daytime pain, nocturnal pain, resting pain and activity pain, and the incidence of DVT in the mild and severe pain groups of daytime and activity pain and moderate to severe pain groups at seventh days after the operation. Statistical differences (two P0.05) were not statistically significant in other groups. Conclusion: pain scores after arthroplasty were significantly correlated with thrombosis. The pain scores in group DVT were higher than those in the non DVT group, and the incidence of DVT in the medium heavy pain group was higher than that in the mild pain group. In the relationship between pain and DVT, the pain and activity of daytime after seventh days after the operation The pain is the greatest.
【學(xué)位授予單位】：南京大學(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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本文編號(hào)：1955923