本文選題：直接前入路 + 髖關(guān)節(jié)置換術(shù)��； 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:經(jīng)直接前入路行初次全髖關(guān)節(jié)置換術(shù)(Total Hip Arthroplasty using a Direct Anterior Approach DAA-THA)后,比較放置引流與不放置引流對患者早期疼痛程度、輸血率、髖關(guān)節(jié)活動度、失血量及并發(fā)癥等臨床療效的影響。方法:采用前瞻性、隨機性的對照研究方法,對執(zhí)行DAA-THA術(shù)后放置引流與不放置引流的患者作早期臨床療效對比研究。使用自體血回輸機作為引流裝置,應(yīng)用隨機分配的方法將25例執(zhí)行DAA-THA的患者放入引流組,將25例執(zhí)DAA-THA的患者放入不引流組,共納入50例髖。觀察手術(shù)前后大腿根部周徑、血紅蛋白、紅細胞壓積、凝血功能、D-2聚體、更換敷料次數(shù)、引流量、輸血率、疼痛程度、失血量、血腫發(fā)生率、瘀斑、血栓發(fā)生率、術(shù)后住院天數(shù)、切口愈合情況、感染發(fā)生率、術(shù)后下地時間、髖關(guān)節(jié)活動度等指標(biāo),做統(tǒng)計學(xué)分析進行比較。結(jié)果:在直接前入路初次全髖關(guān)節(jié)置換術(shù)后1d、2d、3d及出院當(dāng)天放置引流組的髖關(guān)節(jié)活動度(P0.05)及視覺模擬評分(P0.05)均優(yōu)于不放置引流組;但術(shù)后血紅蛋白下降水平則引流組大于不引流組(P=0.031),不放置引流組有2例輸血(8%),放置引流組有4例輸血(16%);其術(shù)后血液丟失總量、術(shù)后住院天數(shù)、瘀斑、大腿周徑差值、更換敷料次數(shù)、術(shù)后凝血功能、D-2聚體、術(shù)后下地時間、拆線時間兩組相比較均無明顯統(tǒng)計學(xué)意義,術(shù)后未發(fā)現(xiàn)下肢深靜脈血栓形成及肺栓塞,均未發(fā)現(xiàn)明顯血腫形成,兩組均無感染,放置引流組和不放置引流組差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:經(jīng)直接前入路行初次全髖關(guān)節(jié)置換術(shù),術(shù)后引流可以減輕患者術(shù)區(qū)疼痛感及獲得更好的髖關(guān)節(jié)活動度,但血紅蛋白丟失及輸血率較不放置引流高,所以權(quán)衡利弊,為了使患者術(shù)后獲得良好早期療效,建議DAA-THA術(shù)后應(yīng)常規(guī)放置引流;另外圍手術(shù)期合理應(yīng)用止血藥和預(yù)防血栓藥,術(shù)后可以減少相關(guān)并發(fā)癥的發(fā)生。
[Abstract]:Objective: total Hip Arthroplasty using a Direct Anterior Approach DAA-THA (Total Hip Arthroplasty using a Direct Anterior Approach DAA-THA) through direct anterior approach was used to compare the degree of pain, blood transfusion rate and hip joint activity between patients with and without drainage. The effect of blood loss and complications. Methods: a prospective, randomized controlled study was conducted to compare the early clinical outcomes of patients with or without drainage after DAA-THA. Using autologous blood transfusion machine as drainage device, 25 patients who performed DAA-THA were put into drainage group by random distribution method, 25 patients with DAA-THA were put into non-drainage group, 50 hips were included. The peripheral diameter of thigh root, hemoglobin, hematocrit, coagulant function and D-2 polymer were observed before and after operation. Dressing change times, drainage rate, blood transfusion rate, pain degree, blood loss, hematoma rate, ecchymosis, thrombus incidence were observed. The hospital stay, wound healing, infection rate, postoperative floor time and hip motion were compared statistically. Results: the hip motion (P0.05) and visual analogue score (P0.05) in the drainage group were better than those in the non-drainage group on the 1st day after the first total hip arthroplasty through the direct anterior approach (P 0.05) and the drainage group on the day of discharge. However, the decrease of hemoglobin level in drainage group was higher than that in non-drainage group (P0. 031), blood transfusion was found in 2 cases (8%) in no drainage group and 4 cases (16%) in drainage group, the total amount of blood loss, postoperative hospitalization days, ecchymosis and thigh diameter difference were observed in the drainage group. There was no significant difference between the two groups in dressing changing times, coagulation function of D-2 polymer after operation, the time of dropping down after operation and the time of removing thread. There was no significant difference between the two groups. No deep vein thrombosis and pulmonary embolism of lower extremities were found after operation, and no obvious hematoma formation was found in the two groups. There was no infection between the two groups. There was no significant difference between the drainage group and the non-drainage group (P0.05). Conclusion: the primary total hip replacement via direct anterior approach can relieve the pain and obtain better hip motion, but the hemoglobin loss and blood transfusion rate are higher than those without drainage. In order to get good early curative effect after operation, it is suggested that drainage should be placed regularly after DAA-THA, and the postoperative complications can be reduced by rational use of hemostatic drugs and thrombus prevention drugs in perioperative period.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4

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