计算机导航联合微创技术对全膝关节置换失血的影响  

Effects of Computer Assisted Minimally Invasive Surgery on Blood Loss after Total Knee Replacement

作　　者：李锋[1] 林雪林[2] 张克[1] 刘延青[1] 刘岩[1] 田华[1] 

机构地区：[1]北京大学第三医院骨科,北京100191 [2]聊城市第二人民医院骨科,聊城252600

出　　处：《中国微创外科杂志》2015年第3期197-200,214,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市科技计划资助项目(项目编号:D121100004212005)

摘　　要：目的探讨计算机导航联合微创技术对全膝关节置换术后失血的影响。方法 2012年8月-2013年10月选择初次接受膝关节置换的骨性关节炎患者,均使用髁间开放型假体,其中导航组40例,传统组40例,根据Ward和Gross方法计算隐性失血量、总失血量,记录输血及并发症。结果导航组与传统组患者术后总失血量分别为（1025±184）ml和（1494±201）ml,有统计学差异（t=10.885,P=0.000）;导航组显性出血量明显少于传统组[（621±188）ml vs.（724±197）ml,t=2.392,P=0.019];导航组隐性出血量明显少于传统组[（404±179）ml vs.（732±204）ml,t=7.644,P=0.000];导航组异体输血率12.5%（5/40）,低于传统组30.0%（12/40）,但无统计学差异（χ^2=3.660,P=0.056）;导航组深静脉血栓形成发生率25.0%（10/40）,低于传统组42.5%（17/40）,但无统计学差异（χ^2=2.739,P=0.098）。结论导航联合微创技术减少术后失血量,相应降低术后异体输血及深静脉血栓发生的机率。Objective To evaluate the impact of minimally invasive technique（ MIS） using a navigation system on postoperative blood loss in total knee arthroplasty（ TKA）. Methods We compared the total blood volume loss in a cohort of patients with osteoarthritis undergoing either computer navigated minimally invasive technique（ n = 40） or standard intramedullary technique（ n = 40）. The total and hidden blood loss was calculated according to the Ward and the Gross method. Results The total blood loss was significantly less in the computer assisted group（ 1025 ± 184） ml as compared with the conventional group（ 1494 ± 201） ml（ t = 10. 885,P = 0. 000）. Patients with a computer navigated procedure and MIS technique had a significantly less dominant blood loss [（ 621 ± 188） ml vs.（ 724 ± 197） ml,t = 2. 392,P = 0. 019] and hidden blood loss [（ 404 ± 179） ml vs.（ 732 ± 204） ml,t = 7. 644,P = 0. 000] as compared with those who underwent a conventional TKA. The blood transfusion rate was12. 5%（ 5 /40） in the computer assisted group and 30. 0%（ 12 /40） in the conventional group,without statistically significant difference（ χ^2= 3. 660,P = 0. 056）. The deep vein thrombosis rate was 25. 0%（ 10 /40） in the computer assisted group and 42. 5%（ 17 /40） in the conventional group, without statistically significant difference（ χ^2= 2. 739,P = 0. 098）. Conclusion Computer navigated TKA combined with MIS technique has benefits of reduced postoperative blood loss,lower blood transfusion and deep vein thrombosis rate.

关 键 词：导航 全膝关节置换 骨性关节炎 

分 类 号：R687.4[医药卫生—骨科学]