糖尿病对人工全膝关节置换术围手术期的影响  

The Influence of Diabetes on Perioperative Period of Total Knee Arthroplasty

作　　者：于大淼[1] 廉永云[1] 

机构地区：[1]哈尔滨医科大学附属第四医院骨五科,哈尔滨150001

出　　处：《医学综述》2014年第9期1686-1688,共3页Medical Recapitulate

摘　　要：目的评估糖尿病对人工全膝关节置换术(TKA)术后切口愈合以及膝关节功能恢复的影响。方法选择2008年8月至2010年12月哈尔滨医科大学附属第四医院骨科收治的接受TKA的患者161例,其中合并有糖尿病者34例,术前调节血糖在6.7~10 mmol/L,尿糖±^+为宜。34例患者每日测三餐前和睡前血糖及尿糖。隐性糖尿病或能用饮食控制者(12例),根据尿糖结果决定是否应用胰岛素。如血糖控制适宜,可择期行TKA,术后加强功能锻炼,并给予美国纽约特种外科医院(HSS)评分系统进行评定。结果本组34例患者获得随访平均30个月。HSS评分由术前29~45(37.0±7.0)分提高到术后80~98(89±8)分(P<0.05)。膝关节活动范围由术前的50°~96°(73±22)°增加到术后100°~120°(110±9)°(P<0.05)。2例患者发生膝部感染并发症。结论术前调整血糖术后可获得满意效果,糖尿病患者TKA术后深部感染愈后效果欠佳。Objective To assess the influence of diabetes on postoperative wound healing and functional recovery of the knee after total knee arthroplasty（TKA）. Methods A total of 161 cases receiving TKA at the Fourth Affiliated Hospital of Harbin Medical University during Aug. 2008 and Dec. 2010 were selected, including 34 cases combined with diabetes mellitus, preoperative blood glucose was adjusted to 6.7-10 mmol/L,urinary glucose ＋ - ＋. Blood glucose and urinary glucose of the 34 patients were measured daily before three meals and at bedtime blood. For latent diabetes or those who use diet control（ 12 cases） ,whether insulin was to be administered was decided according to the results of urinary glucose result. If appropriate glycemic control was achieved, TKA would be given on a selected day, postoperative functional exercise was strengthened and HSS scoring system was adopted for assessment. Results The 34 patients were followed up for an average of 30 months. HSS score improved from 29-45 （37.0 ± 8 ） points before surgery to 80-98 （89 ± 9 ） points after surgery （P 〈 0.05 ）. Knee range of motion improved from preoperative level 50°-96°（73 ± 22） ° to postoperative 100°-120°（ 110 ±9 ）°（p 〈 0.05 ）. Two patients had the complication of knee infection. Conclusion Preoperative blood glucose control can obtain satisfactory results. Deep infection healing effect of diabetic patients after TKA is less than satisfactory.

关 键 词：糖尿病 全膝关节置换术 感染 

分 类 号：R473.6[医药卫生—护理学]