中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
4期
1553-1556
,共4页
徐昭宁%杨旭%田少奇%胡百强%孙康
徐昭寧%楊旭%田少奇%鬍百彊%孫康
서소저%양욱%전소기%호백강%손강
膝关节,人工%滑膜%骨关节炎
膝關節,人工%滑膜%骨關節炎
슬관절,인공%활막%골관절염
Knee prosthesis%Synovial membrane%Osteoarthritis
目的探讨全膝关节置换术（ TKR）时同时行滑膜切除术对术后失血及膝关节功能恢复的影响。方法对我院2010年9月至2011年9月因骨性关节炎（ OA）入院并拟行单侧TKR的患者187例，随机分为两组，试验组（男30例，女66例）为TKR术中切除滑膜，对照组（男18例，女73例）为TKR术中保留滑膜。通过Gross方程计算出两组术后隐性失血量，比较两组术后输血率、引流量、隐性失血量、住院时间、手术时间、术后24 h、3 d及4周平均疼痛视觉模拟评分（ VAS）、术后4周及12个月时膝关节协会临床评分和功能评分（ KSS）、术后12个月浮髌试验阳性率等指标。结果两组隐性失血量差异有统计学意义（ P ＝0.042），两组引流量差异有统计学意义（P＝0.03），两组手术时间差异有统计学意义（P＝0.006），两组术后输血率、术后平均住院天数、术后3 d膝关节活动度差异无统计学意义。两组术后24 h、3 d及4周后平均VAS疼痛评分差异无统计学意义。两组术后4周平均KSS临床评分及功能评分差异无统计学意义。两组术后12个月平均KSS临床评分及功能评分差异无统计学意义。两组术后12个月浮髌试验阳性率差异无统计学意义。结论在行TKR治疗OA时，术中行滑膜切除与保留滑膜相比，在患肢功能恢复及疼痛缓解方面无任何优势，只增加了术后出血及延长了手术时间。
目的探討全膝關節置換術（ TKR）時同時行滑膜切除術對術後失血及膝關節功能恢複的影響。方法對我院2010年9月至2011年9月因骨性關節炎（ OA）入院併擬行單側TKR的患者187例，隨機分為兩組，試驗組（男30例，女66例）為TKR術中切除滑膜，對照組（男18例，女73例）為TKR術中保留滑膜。通過Gross方程計算齣兩組術後隱性失血量，比較兩組術後輸血率、引流量、隱性失血量、住院時間、手術時間、術後24 h、3 d及4週平均疼痛視覺模擬評分（ VAS）、術後4週及12箇月時膝關節協會臨床評分和功能評分（ KSS）、術後12箇月浮髕試驗暘性率等指標。結果兩組隱性失血量差異有統計學意義（ P ＝0.042），兩組引流量差異有統計學意義（P＝0.03），兩組手術時間差異有統計學意義（P＝0.006），兩組術後輸血率、術後平均住院天數、術後3 d膝關節活動度差異無統計學意義。兩組術後24 h、3 d及4週後平均VAS疼痛評分差異無統計學意義。兩組術後4週平均KSS臨床評分及功能評分差異無統計學意義。兩組術後12箇月平均KSS臨床評分及功能評分差異無統計學意義。兩組術後12箇月浮髕試驗暘性率差異無統計學意義。結論在行TKR治療OA時，術中行滑膜切除與保留滑膜相比，在患肢功能恢複及疼痛緩解方麵無任何優勢，隻增加瞭術後齣血及延長瞭手術時間。
목적탐토전슬관절치환술（ TKR）시동시행활막절제술대술후실혈급슬관절공능회복적영향。방법대아원2010년9월지2011년9월인골성관절염（ OA）입원병의행단측TKR적환자187례，수궤분위량조，시험조（남30례，녀66례）위TKR술중절제활막，대조조（남18례，녀73례）위TKR술중보류활막。통과Gross방정계산출량조술후은성실혈량，비교량조술후수혈솔、인류량、은성실혈량、주원시간、수술시간、술후24 h、3 d급4주평균동통시각모의평분（ VAS）、술후4주급12개월시슬관절협회림상평분화공능평분（ KSS）、술후12개월부빈시험양성솔등지표。결과량조은성실혈량차이유통계학의의（ P ＝0.042），량조인류량차이유통계학의의（P＝0.03），량조수술시간차이유통계학의의（P＝0.006），량조술후수혈솔、술후평균주원천수、술후3 d슬관절활동도차이무통계학의의。량조술후24 h、3 d급4주후평균VAS동통평분차이무통계학의의。량조술후4주평균KSS림상평분급공능평분차이무통계학의의。량조술후12개월평균KSS림상평분급공능평분차이무통계학의의。량조술후12개월부빈시험양성솔차이무통계학의의。결론재행TKR치료OA시，술중행활막절제여보류활막상비，재환지공능회복급동통완해방면무임하우세，지증가료술후출혈급연장료수술시간。
Objective To explore the effect of synovectomy on the time of the surgery , bleeding , postoperative pain , clinical and function outcome after the total knee replacement ( TKR ) for the patients who got primary osteoarthritis ( OA ) .Methods A total of 187 patients with primary OA who planed to get TKR were included in this study .They were divided into two groups randomly .Group 1 was study group ( TKR with synovectomy ) ,group 2 was control group ( TKR without synovectomy ) .All patients and operators who appraise patients before and after the surgery were blind to the result of subgroup .The surgery time , hospitalization time , invisible bleeding ,drainage volume ,blood transfusion rate were statistical analyzed between two groups .Patients were followed up at 4 weeks and 12 months after their operation .Knee joint pain , knee society score ( KSS ) and the positive rate of floating patella test were statistical analyzed between two groups .Results The invisible bleeding of the study group was significantly higher than the control group ( P=0.042 ) .The drainage volume of the study group was significantly higher than the control group ( P=0.030 ) .The surgery time of the study group was significantly longer than the control group ( P =0.006 ) .There was no significant difference in blood transfusion rate , hospitalization time between two groups .At 4 weeks and 12 months after the operation , there was no significant difference in postoperative pain , the KSS clinical and function score and the positive rate of floating patella test between two groups .Conclusions Compared with TKR without synovectomy ,patients with primary osteoarthritis got TKR with synovectomy do not have any clinical and function advantages .On the contrary ,they have a higher invisible bleeding,drainage volume and longer surgery time .
