CAJ | 학술논문

目的：探讨全膝关节置换术中分时段应用止血带的疗效和安全性。方法选取2010-2012年在某院初次进行全膝关节置换术的患者80例，通过计算机随机分组的方式，将其随机分为试验组和对照组，每组40例，试验组患者术中使用止血带的时机为截骨开始至结束，对照组则是在整个术中全程使用止血带，比较两组患者的术中各项重要指标，术后1，3，5 d血红蛋白量及RBC计数，以及两组患者术后并发症发生情况。结果试验组患者的手术时间、术中出血量分别为（136．7±18．6） min，（167．8±16．8）ml，对照组分别为（138．6±19．4）min，（174．8±14．6）ml，两组比较，差异无统计学意义（t分别为0．447，1．989；P＞0．05），试验组患者术后1，3，5 d血红蛋白值分别为（7．6±0．8），（15．9±1．1），（16．3±1．3）g／L，对照组分别为（7．9±0．7），（16．4±1．2），（16．8±1．1）g／L，两组比较，差异无统计学意义（t分别为1．785，1．943，1．857；P＞0．05），试验组患者术后1，3，5 d RBC计数分别为（0．18±0．02），（1．23±0．22），（1．58±0．39）×1012／L，对照组分别为（0．19±0．03），（1．34±0．28），（1．74±0．42）×1012／L，两组比较，差异无统计学意义（ t分别为1．754，1．954，1．766；P＞0．05）。对照组并发症发生率为52．5％，其中深静脉血栓6例，Ⅱ期愈合伤口感染4例，膝关节血肿7例，腓总神经损伤4例。试验组并发症发生率为5．0％，其中深静脉血栓1例，膝关节血肿1例，试验组低于对照组，差异有统计学意义（χ2＝22．029，P＜0．05）。结论全膝关节置换术时分中段应用止血带，术后患者的并发症较少，有利于患者的预后。
목적：탐토전슬관절치환술중분시단응용지혈대적료효화안전성。방법선취2010-2012년재모원초차진행전슬관절치환술적환자80례，통과계산궤수궤분조적방식，장기수궤분위시험조화대조조，매조40례，시험조환자술중사용지혈대적시궤위절골개시지결속，대조조칙시재정개술중전정사용지혈대，비교량조환자적술중각항중요지표，술후1，3，5 d혈홍단백량급RBC계수，이급량조환자술후병발증발생정황。결과시험조환자적수술시간、술중출혈량분별위（136．7±18．6） min，（167．8±16．8）ml，대조조분별위（138．6±19．4）min，（174．8±14．6）ml，량조비교，차이무통계학의의（t분별위0．447，1．989；P＞0．05），시험조환자술후1，3，5 d혈홍단백치분별위（7．6±0．8），（15．9±1．1），（16．3±1．3）g／L，대조조분별위（7．9±0．7），（16．4±1．2），（16．8±1．1）g／L，량조비교，차이무통계학의의（t분별위1．785，1．943，1．857；P＞0．05），시험조환자술후1，3，5 d RBC계수분별위（0．18±0．02），（1．23±0．22），（1．58±0．39）×1012／L，대조조분별위（0．19±0．03），（1．34±0．28），（1．74±0．42）×1012／L，량조비교，차이무통계학의의（ t분별위1．754，1．954，1．766；P＞0．05）。대조조병발증발생솔위52．5％，기중심정맥혈전6례，Ⅱ기유합상구감염4례，슬관절혈종7례，비총신경손상4례。시험조병발증발생솔위5．0％，기중심정맥혈전1례，슬관절혈종1례，시험조저우대조조，차이유통계학의의（χ2＝22．029，P＜0．05）。결론전슬관절치환술시분중단응용지혈대，술후환자적병발증교소，유리우환자적예후。
Objective To explore the effect and safety of using tourniquet to patients during different time interval of total knee arthroplasty .Methods A total of 80 cases of patients , who had total knee arthroplasty at our hospital from 2010 to 2012 , were divided into the experimental group and the control group randomly , according to the computer random grouping method , 40 cases each .The patients in the experimental group were used the tourniquet method when the osteotomy began .The tourniquet was used to the control group during the whole operation process .Various intraoperative indexes were compared between groups:hemoglobin content (1, 3 and 5 day postoperatively ) , red blood cell count and postoperative complications .Results The operation time and lose of blood volume of patients in the experimental group were (136.7 ±18.6) min and (167.8 ±16.8) ml.The operation time and lose of blood volume of patients in the control group were (138.6 ±19.4) min and (174.8 ±14.6) ml.There were no significant differences between these two groups of patients (t =0.447, 1.989, respectively;P>0.05).The hemoglobin content of 1, 3 and 5 days postoperatively of the experimental group were (7.6 ±0.8), (15.9 ±1.1) and (16.3 ±1.3) g/L, respectively.The hemoglobin content of 1, 3 and 5 days postoperatively of the control group were (7.9 ±0.7), (16.4 ±1.2) and (16.8 ±1.1) g/L, respectively.The comparison between groups were without statistical differences (t=1.785, 1.943, 1.857, respectively;P>0.05).The red blood cell count of 1, 3 and 5 days postoperatively of the experimental group were (0.18 ±0.02), (1.23 ±0.22) and (1.58 ±0.39) ×1012/L, respectively.The red blood cell count of 1, 3 and 5 days postoperatively of the control group were (0.19 ±0.03), (1.34 ±0.28) and (1.74 ±0.42) × 1012/L, respectively.The comparison between groups were without statistical differences (t=1.754, 1.954, 1.766, respectively;P>0.05).The incidence of postoperative complication in the control group was 52.5%, among which 6 cases suffered deep vein thrombosis , 4 cases suffered phase Ⅱwound infection , 7 cases suffered knee joint cavity heamatoma and 4 cases suffered common peroneal nerve injury .The incidence of postoperative complication in the experimental group was 5.0%, among which 1 cases suffered deep vein thrombosis , and 1 case suffered heamatoma of knee joint cavity .There was no significant difference (χ2 =22.029, P<0.05). Conclusions Application the tourniquet method to patients during different time interval of total knee arthroplasty can reduce patients ’ postoperative complications , and it makes great contribution to patients ’ postoperative recovery .