CAJ | 학술논문

目的探讨人工全膝关节置换术(TKA)后伤口周围瘀斑形成的危险因素.方法 2007年1月至2010年5月对102例患者行单侧TKA,男14例,女88例;年龄5I～79岁,平均(65.9±7.1)岁;平均体质量指数(BMI)为(28.6±4.8)kg/m2.回顾性分析15项临床因素(连续变量7项、分类变量8项)与术后发生伤口周围瘀斑的相关性.连续变量包括:年龄、BMI、手术时间、输血总量、术前、术后血小板计数及术后使用抗凝药物时间,分类变量包括:性别、是否正在使用激素、有无糖尿病、有无原发性高血压、有无关节畸形、术后有无DVT临床表现、有无引流管夹闭及有无使用抗凝药物.102例患者按照是否发生伤口周围瘀斑分成两组:连续变量采用t检验、分类变量采用x2检验进行比较,并将所有15项因素进行多因素Logistic回归分析. 结果 102例患者中14例术后发现伤口周围瘀斑,发生率为13.7%.单因素分析发现输血因素差异有统计学意义(t=2.707,P=0.008);输血量＞400mL与输血量＜400mL比较差异有统计学意义(χ2=7.495,P=0.024).年龄、体质量指数、手术时间、术前、术后血小板计数及术后使用抗凝药物时间等因素对瘀斑发生无影响,差异均无统计学意义(P＞0.05).术后有引流管夹管与无夹管对瘀斑发生有影响,差异有统计学意义(χ2=5.386,P=0.020).多因素分析得到术后输血、有引流管夹管是伤口周围瘀斑形成的重要危险因素(P＜0.05). 结论TKA后输血和伤口引流管夹管或引流不畅出现伤口周围瘀斑的风险高.术后应控制输血量,放置引流管时在明确无大血管损伤的情况下尽量不要用夹管,并保证引流管通畅.
목적 탐토인공전슬관절치환술(TKA)후상구주위어반형성적위험인소.방법 2007년1월지2010년5월대102례환자행단측TKA,남14례,녀88례;년령5I～79세,평균(65.9±7.1)세;평균체질량지수(BMI)위(28.6±4.8)kg/m2.회고성분석15항림상인소(련속변량7항、분류변량8항)여술후발생상구주위어반적상관성.련속변량포괄:년령、BMI、수술시간、수혈총량、술전、술후혈소판계수급술후사용항응약물시간,분류변량포괄:성별、시부정재사용격소、유무당뇨병、유무원발성고혈압、유무관절기형、술후유무DVT림상표현、유무인류관협폐급유무사용항응약물.102례환자안조시부발생상구주위어반분성량조:련속변량채용t검험、분류변량채용x2검험진행비교,병장소유15항인소진행다인소Logistic회귀분석. 결과 102례환자중14례술후발현상구주위어반,발생솔위13.7%.단인소분석발현수혈인소차이유통계학의의(t=2.707,P=0.008);수혈량＞400mL여수혈량＜400mL비교차이유통계학의의(χ2=7.495,P=0.024).년령、체질량지수、수술시간、술전、술후혈소판계수급술후사용항응약물시간등인소대어반발생무영향,차이균무통계학의의(P＞0.05).술후유인류관협관여무협관대어반발생유영향,차이유통계학의의(χ2=5.386,P=0.020).다인소분석득도술후수혈、유인류관협관시상구주위어반형성적중요위험인소(P＜0.05). 결론TKA후수혈화상구인류관협관혹인류불창출현상구주위어반적풍험고.술후응공제수혈량,방치인류관시재명학무대혈관손상적정황하진량불요용협관,병보증인류관통창.
Objective To analyze clinical risk factors for ecchymosis around the wound after total knee arthroplasty (TKA). Methods From January, 2007 to May, 2010, 102 patients, 14 men and 88 women, received TKA in our hospital. Their average age was (65.9 ±7. 1) years (range, 51 to 79 years).Their average body mass index was (28. 6 ± 4. 8) kg/m2. Fifteen clinical factors were analyzed retrospectively to determine their associations with postoperative ecchymosis around the wound. Seven continuous variables were analyzed by t and χ2 tests while 8 categorical variables were analyzed by one-way ANOVO. All the 15 possible risk factors for postoperative ecchymosis around the wound were analyzed with multivariate logistic regression. Results The incidence of ecchymosis around the wound in this series was 13.7%(14/102). Single factor analysis indicated difference in blood transfusion was significant (t = 2. 707, P =0. 008);χ2 test indicated difference in blood transfusion volume (＞ 400 mL vs. ＜ 400 mL) was significant (χ2 =7. 495, P =0. 024) . Single factor χ2 test showed drainage-clamping vs. non-drainage-clamping was significant (χ2 = 5. 386, P = 0. 020). Logistic regression analysis indicated that blood transfusion and wound drainage-clamping were the risk factors for the occurrence of ecchymosis around the wound after the TKA.Concluslons Blood transfusion and wound drainage-clamping may be the risk factors for occurrence of ecchymosis around the wound after TKA. Consequently, blood transfusion volume should be controlled and clamping should be avoided as much as possible to ensure smooth drainage if no major vascular injury exists.