人工全膝关节置换术后伤口周围瘀斑形成的危险因素分析  

Risk factors for ecchymosis around the wound after total knee arthroplasty

作　　者：康焱[1] 傅明[1] 盛璞义[1] 何爱珊[1] 杨忠汉[1] 杨子波[1] 徐栋梁[1] 廖威明[1] 

机构地区：[1]中山大学附属第一医院关节外科,广州510080

出　　处：《中华创伤骨科杂志》2010年第12期1135-1138,共4页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（30872615）

摘　　要：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.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.

关 键 词：关节成形术 置换 膝 瘀斑 危险因素 

分 类 号：R686[医药卫生—骨科学]