中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2011年
3期
242-246
,共5页
鲍航行%王金法%蔡运火%储小兵%吕成%童培建
鮑航行%王金法%蔡運火%儲小兵%呂成%童培建
포항행%왕금법%채운화%저소병%려성%동배건
止血带%关节成形术,置换,膝%手术后并发症
止血帶%關節成形術,置換,膝%手術後併髮癥
지혈대%관절성형술,치환,슬%수술후병발증
Tourniquet%Arthroplasty,replacement,knee%Postoperative complications
目的 探讨全膝关节置换术(TKA)中使用止血带是否会导致缺血再灌注损伤,进而加重各项不良并发症。方法 2009年1月至2010年10月共收治52例拟行初次TKA的患者,采用随机数学表法分为2组:使用止血带组(A组)和未使用止血带组(B组),每组26例。A组:男11例,女15例;年龄69 ~ 76岁,平均72.5岁。B组:男12例,女14例;年龄67 ~ 77岁,平均72.9岁。两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。术后股四头肌活检观测股四头肌肌肉的病理改变,记录并比较两组患者的术后肿胀程度、疼痛视觉模拟评分(VAS)、关节活动度及肌力。结果 A组病理切片示股四头肌溶解,大量中性粒细胞浸润;B组为正常肌肉组织。A组术后1、3、7及14d小腿肿胀程度、膝关节周径及股四头肌肿胀程度的增加率均显著大于B组,差异有统计学意义(P<0.05)。A组术后6h、1d、3d、5d、7 dVAS疼痛评分明显高于B组,差异均有统计学意义(P<0.05);而术后14d两组VAS疼痛评分差异无统计学意义(P>0.05)。B组患者术后3d、7d、14d及1个月膝关节自主活动度均高于A组,术后1、3、7、14d直腿抬高度数也明显优于A组,差异均有统计学意义(P<0.05)。结论 TKA中使用止血带可引起缺血再灌注损伤,进而加重各项不良并发症的发生。
目的 探討全膝關節置換術(TKA)中使用止血帶是否會導緻缺血再灌註損傷,進而加重各項不良併髮癥。方法 2009年1月至2010年10月共收治52例擬行初次TKA的患者,採用隨機數學錶法分為2組:使用止血帶組(A組)和未使用止血帶組(B組),每組26例。A組:男11例,女15例;年齡69 ~ 76歲,平均72.5歲。B組:男12例,女14例;年齡67 ~ 77歲,平均72.9歲。兩組患者術前一般資料比較差異均無統計學意義(P>0.05),具有可比性。術後股四頭肌活檢觀測股四頭肌肌肉的病理改變,記錄併比較兩組患者的術後腫脹程度、疼痛視覺模擬評分(VAS)、關節活動度及肌力。結果 A組病理切片示股四頭肌溶解,大量中性粒細胞浸潤;B組為正常肌肉組織。A組術後1、3、7及14d小腿腫脹程度、膝關節週徑及股四頭肌腫脹程度的增加率均顯著大于B組,差異有統計學意義(P<0.05)。A組術後6h、1d、3d、5d、7 dVAS疼痛評分明顯高于B組,差異均有統計學意義(P<0.05);而術後14d兩組VAS疼痛評分差異無統計學意義(P>0.05)。B組患者術後3d、7d、14d及1箇月膝關節自主活動度均高于A組,術後1、3、7、14d直腿抬高度數也明顯優于A組,差異均有統計學意義(P<0.05)。結論 TKA中使用止血帶可引起缺血再灌註損傷,進而加重各項不良併髮癥的髮生。
목적 탐토전슬관절치환술(TKA)중사용지혈대시부회도치결혈재관주손상,진이가중각항불량병발증。방법 2009년1월지2010년10월공수치52례의행초차TKA적환자,채용수궤수학표법분위2조:사용지혈대조(A조)화미사용지혈대조(B조),매조26례。A조:남11례,녀15례;년령69 ~ 76세,평균72.5세。B조:남12례,녀14례;년령67 ~ 77세,평균72.9세。량조환자술전일반자료비교차이균무통계학의의(P>0.05),구유가비성。술후고사두기활검관측고사두기기육적병리개변,기록병비교량조환자적술후종창정도、동통시각모의평분(VAS)、관절활동도급기력。결과 A조병리절편시고사두기용해,대량중성립세포침윤;B조위정상기육조직。A조술후1、3、7급14d소퇴종창정도、슬관절주경급고사두기종창정도적증가솔균현저대우B조,차이유통계학의의(P<0.05)。A조술후6h、1d、3d、5d、7 dVAS동통평분명현고우B조,차이균유통계학의의(P<0.05);이술후14d량조VAS동통평분차이무통계학의의(P>0.05)。B조환자술후3d、7d、14d급1개월슬관절자주활동도균고우A조,술후1、3、7、14d직퇴태고도수야명현우우A조,차이균유통계학의의(P<0.05)。결론 TKA중사용지혈대가인기결혈재관주손상,진이가중각항불량병발증적발생。
Objective To explore whether use of tourniquet in total knee arthroplasty (TKA) will lead to increased risks of ischemia-reperfusion injury and adverse complications. MethodsFifty-two patients who were to undergo primary TKA between January, 2009 and October, 2010 were randomly divided into 2 equal groups. A tourniquet was used in group A but not in group B. In group A, there were 11 males and 15 females; aged from 69 to 76 years (mean, 72. 5 years); in group B, there were 12 males and 14 females, aged 67 to 77 years (mean, 72.9 years). There were no statistically significant differences between the 2 groups in demographic characteristics before surgery. Pathological changes in the quadriceps muscle were compared between the 2 groups through biopsy. Severity of postoperative swelling, pain scores by visual analogue scale (VAS), range of motion and muscle strength were recorded and compared between the 2 groups.ResultsThe biopsy showed dissolved quadriceps and massive neutrophil infiltration in group A but normal muscle tissue in group B. Swellings of the calf, the knee and the quadriceps at 1, 3, 7 and 14 days after surgery were all significantly more severe in group A than in group B ( P < 0. 05 ). The VAS pain scores at 6 hours, 1, 3, 5, 7 days were significantly higher in group A than in group B ( P < 0. 05 ), but there was no significant difference in the VAS pain score at 14 days between the 2 groups ( P > 0. 05). Group B had a significantly greater range of spontaneous activity of the knee at 3, 7, 14 days and 1 month after surgery than group A( P <0. 05); group B also showed significantly better straight leg raising at 1, 3, 7, 14 days than group A ( P < 0. 05) .Conclusion TKA using tourniquet may increase risks of ischemia-reperfusion injury and adverse complications.