【摘要】：目的本研究通過前瞻性觀察全膝關(guān)節(jié)置換術(shù)(TKA)后患肢早期局部癥狀群,總結(jié)癥狀群所呈現(xiàn)的規(guī)律特征,探究癥狀群之間的相互關(guān)系,為臨床更好地防治TKA術(shù)后局部并發(fā)癥提供參考依據(jù)。方法本研究以手術(shù)時間為準(zhǔn),收集2014年1月到2014年12月在廣東省中醫(yī)院骨三科行全膝關(guān)節(jié)置換術(shù)的患者,觀察TKA術(shù)前1天、術(shù)后第2、4、7、14天患肢腫脹程度、疼痛程度、疼痛區(qū)域、瘀斑區(qū)域、麻木區(qū)域、雙膝皮溫變化,初步總結(jié)出TKA術(shù)后早期局部癥狀群規(guī)律。結(jié)果本研究共收集我科晚期膝骨性關(guān)節(jié)炎患者124例,其中7例患者采取分期行雙膝關(guān)節(jié)置換術(shù),手術(shù)例數(shù)共131例。男性18例,占14.5%,女性106例,占85.5%。在124例TKA患者中,以55-75歲患者為主,共有90例,占72.5%,55歲以下的患者共4例,占3.4%,而75歲以上的患者共30例,占24.1%。BMI肥胖者占73.4%,正常者占26.6%。腫脹程度變化、疼痛程度變化、皮溫變化根據(jù)觀察時點各自采用重復(fù)測量方差分析,結(jié)果顯示有統(tǒng)計學(xué)意義(P0.05)。觀察結(jié)果顯示：術(shù)后2天疼痛較術(shù)前緩解、術(shù)后4天疼痛少許加重,術(shù)后7天疼痛達到峰值,之后開始回落,到術(shù)后14天疼痛明顯減輕。不同觀察時點疼痛集中區(qū)域各異。腫脹從術(shù)后開始出現(xiàn)并不斷增加,到術(shù)后4天腫脹達到峰值,后逐漸減退直至恢復(fù)正常。不同觀察時點瘀斑集中區(qū)域各異。每位患者術(shù)后各時點麻木出現(xiàn)部位相一致,主要集中在外下區(qū),但患者之間的麻木集中區(qū)域仍有少許差異。術(shù)后患者雙膝關(guān)節(jié)皮溫均升高,術(shù)后2天雙膝皮溫達到峰值,但患側(cè)皮溫升高幅度更大,之后均逐漸回落。術(shù)后腫脹程度、疼痛程度、皮溫之間采用Pearson相關(guān)系數(shù)分析,結(jié)果顯示存在正相關(guān)性,其中腫脹與皮溫相關(guān)性最強。結(jié)論TKA術(shù)后患肢早期局部癥狀群各自呈現(xiàn)出一定的規(guī)律特征,且癥狀之間存在相互聯(lián)系,以致出現(xiàn)不同癥狀的相互組合,形成不同的癥狀群特征。因此,初步總結(jié)出TKA術(shù)后局部癥狀群的變化規(guī)律,為今后進一步地提高手術(shù)技術(shù)以及做好TKA術(shù)后的防治工作提供了重要參考。
[Abstract]:Objective to observe the early local symptom groups of the affected limbs after total knee arthroplasty (TKA), summarize the regular characteristics of the symptom groups, and explore the relationship between the symptom groups. To provide reference for clinical better prevention and treatment of local complications after TKA. Methods from January 2014 to December 2014, total knee arthroplasty was performed in the department of bone of Guangdong Provincial Hospital of traditional Chinese Medicine. The degree of limb swelling and pain were observed 1 day before TKA and 714 days after operation. The changes of pain, ecchymosis, numbness and knee skin temperature were summarized. Results 124 cases of advanced knee osteoarthritis were collected in this study. Among them, 7 cases were treated with double knee arthroplasty by stages, 131 cases were operated. There were 18 males (14.5%) and 106 females (85.5%). Of the 124 patients with TKA, 90 were aged 55-75, accounting for 4 patients under 55 years of age (3.4%), while 30 cases were over 75 years old, accounting for 73.4% of 24.1%.BMI obesity. The normal rate was 26.6%. The changes of swelling degree, pain degree and skin temperature were analyzed by repeated measurement variance according to the observed time points. The results showed that there was statistical significance (P0.05). The results showed that the pain was relieved at 2 days after operation, slightly aggravated at 4 days after operation, reached the peak at 7 days after operation, then began to fall back, and obviously relieved at 14 days after operation. Pain concentration areas vary at different observation points. The swelling began to appear and increase, reached the peak at 4 days after operation, then gradually decreased until it returned to normal. The concentration of ecchymosis was different in different observation time. Each patient had the same numbness at each time point after operation, mainly concentrated in the inferior area, but there was still a little difference in the numbness area between the patients. After operation, the skin temperature of both knees increased, and reached the peak on the 2nd day after operation, but the range of the skin temperature on the affected side increased more, and then decreased gradually. The degree of swelling, the degree of pain and the skin temperature were analyzed by Pearson correlation coefficient. The results showed that there was a positive correlation between swelling and skin temperature, and the correlation between swelling and skin temperature was the strongest. Conclusion the early local symptom groups of the affected limbs after TKA have their own regular characteristics, and the symptoms are related to each other, resulting in different symptom combinations and forming different symptom groups. Therefore, the change rule of local symptom group after TKA is summarized, which provides an important reference for further improving the operation technique and doing well the prevention and treatment of TKA.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(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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