CAJ | 학술논문

目的探讨糖尿病患者初次行全膝关节置换(total knee arthroplasty,TKA)时围手术期应注意的问题及其临床疗效.方法回顾性分析2012年1月至2012年12月接受TKA的148例(168膝)糖尿病患者资料,男32例(36膝),女116例(132膝);年龄49～ 80岁,平均(67.2±8.1)岁;骨关节炎136例,类风湿关节炎12例.患者均存在跛行和膝关节疼痛.1 16膝术前存在不同程度的畸形.患者入院时空腹血糖平均(10.1±4.9) mmol/L,尿糖(-)～(+++).经口服降糖药或注射胰岛素,待患者空腹血糖＜ 7.8 mmol/L,餐后2h血糖＜10 mmol/L时行TKA.结果患者术前空腹血糖平均(7.2±1.2) mmol/L,餐后2h血糖平均(11.0±1.8) mmo/L.手术时间平均(72±19) min,术后引流量平均(213.1±101.0) ml,总失血量平均(771.4±97.2) ml.12例患者输血,输血率8.1％(12/148).术后下肢血管彩超示5例患者小腿肌间静脉形成血栓,但无一例形成深静脉血栓.随访时间6.1～ 14.4个月,平均(9.4±2.9)个月.末次随访时,无一例发生假体松动、移位或翻修.美国纽约特种外科医院膝关节评分由术前的平均(38.8±14.3)分提高到术后(92.1±6.1)分,其中优120例,良48例;优良率为100％.膝关节活动范围由术前的平均77.2°±19.3°增加到术后109.9°± 11.1°.无一例发生深部感染.结论糖尿病患者初次行TKA时,如围手术期全面评估心肺情况,积极预防深静脉血栓形成和感染,则早期临床疗效满意,并无更高的感染和深静脉血栓形成风险.
목적 탐토당뇨병환자초차행전슬관절치환(total knee arthroplasty,TKA)시위수술기응주의적문제급기림상료효.방법 회고성분석2012년1월지2012년12월접수TKA적148례(168슬)당뇨병환자자료,남32례(36슬),녀116례(132슬);년령49～ 80세,평균(67.2±8.1)세;골관절염136례,류풍습관절염12례.환자균존재파행화슬관절동통.1 16슬술전존재불동정도적기형.환자입원시공복혈당평균(10.1±4.9) mmol/L,뇨당(-)～(+++).경구복강당약혹주사이도소,대환자공복혈당＜ 7.8 mmol/L,찬후2h혈당＜10 mmol/L시행TKA.결과 환자술전공복혈당평균(7.2±1.2) mmol/L,찬후2h혈당평균(11.0±1.8) mmo/L.수술시간평균(72±19) min,술후인류량평균(213.1±101.0) ml,총실혈량평균(771.4±97.2) ml.12례환자수혈,수혈솔8.1％(12/148).술후하지혈관채초시5례환자소퇴기간정맥형성혈전,단무일례형성심정맥혈전.수방시간6.1～ 14.4개월,평균(9.4±2.9)개월.말차수방시,무일례발생가체송동、이위혹번수.미국뉴약특충외과의원슬관절평분유술전적평균(38.8±14.3)분제고도술후(92.1±6.1)분,기중우120례,량48례;우량솔위100％.슬관절활동범위유술전적평균77.2°±19.3°증가도술후109.9°± 11.1°.무일례발생심부감염.결론 당뇨병환자초차행TKA시,여위수술기전면평고심폐정황,적겁예방심정맥혈전형성화감염,칙조기림상료효만의,병무경고적감염화심정맥혈전형성풍험.
Objective To evaluate the perioperative safety and clinical efficacy of primary total knee arthroplasty in patients with diabetes.Methods Among the patients who were treated with total knee arthroplasty,there were 148 patients (168 knees) associated with diabetes.There were 32 male (36 knees) and 116 female (132 knees),the average age was 67.2 years (range,49-80 years).Osteoarthritis was diagnosed in 136 patients and rheumatoid arthritis was diagnosed in 12 patients.Different degrees of preoperative knee deformities were found in 116 knees.The average fasting blood glucose was 10.1±4.9 mmol/L at the admission time.The glycemic goals was set as:fasting blood glucose ＜ 7.8,2 h postpradndial blood glucose ＜ 10 mmol/L.Results After regular regulating of the blood glucose,the average preoperative fasting blood glucose was 7.2± 1.2 mmol/L,up to 9.9mmol/L.The average postprandial blood glucose was 11.0± 1.8 mmol/L.The mean duration of surgery was 72± 19 min,intraoperative blood loss was few and the mean drainage volume was 213.1±101.0 ml.The average total blood loss was 771.4±97.2 ml.Transfusion was needed in 12 patients (8.1％).Calf muscle venous thrombosis was found in 5 patients,while no deep vein thrombosis was found.The average length of stay was 13.0±4.4 days and the average follow-up time was 9.4±2.9 months.At the final follow-up time point,no prosthesis loosening was found and no revision was needed in any patients.The mean HSS scores increased from the preoperative 38.8± 14.3 to the postoperative 92.1±6.1,the excellent rate was 100％.The knee range of motion raised from preoperative 77.2°±19.3° to the postoperative 109.9°±11.1°.No deep infection was found.Conclusion Diabetic patients do not seem to have a significantly higher risk for infection and DVT after TKA.The early clinical outcomes of the patients with diabetes were satisfied.A comprehensive assessment of perioperative cardiopulmonary conditions should be conducted and active prevention of deep vein thrombosis and infection should be performed.