膝关节置换术中改良止血法结合富血小板血浆的临床研究  

Clinical study of modified hemostasis combined with platelet-rich plasma in total knee arthroplasty

作　　者：周智[1] 袁东堂[1] 谢跃[1] 王黎明[2] 

机构地区：[1]南京医科大学附属淮安第一医院骨科,223300 [2]南京医科大学附属南京医院骨科,210000

出　　处：《中华关节外科杂志（电子版）》2015年第3期21-25,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的观察在人工全膝关节置换(TKA)术中采用富血小板血浆(PRP)减少出血、改善膝关节功能的疗效。方法 2013年1月至2014年1月,将60例符合选择标准的拟行人工TKA术患者纳入研究。其中30例在应用改良止血方法关节置换后关节囊内局部喷撒术中制备的自体PRP和血凝酶(实验组),另30例应用改良止血方法关节置换后喷涂同等剂量的生理盐水和血凝酶(对照组)。术后两组患者均延迟12 h开放引流及相应功能锻炼。记录两组手术时间,术中软组织松解程度,术后第2天血常规,创腔引流量,计算围手术期总失血量;并比较术后切口炎性反应程度、深静脉血栓(DVT)的发生率、深部感染情况;最后比较直腿抬高时间、膝关节主动活动达90°的时间及术后7、15、90 d的关节活动度。结果实验组术后第2天血红蛋白、红细胞压积值明显高于对照组,术后引流量和围手术期总失血量显著低于对照组,差异均有统计学意义(P<0.05)。实验组主动屈曲达90°的时间以及术后7、15 d实验组膝关节主动活动度方面优于对照组,差异有统计学意义(P<0.05);实验组和对照组的手术时间、术中软组织松解程度及术后血小板计数、凝血酶原时间、活化部分凝血激酶时间、术后5 d切口炎性反应程度、DVT的发生率、深部感染发生率、直腿抬高时间、术后90 d随访两组关节活动度,两组比较差异无统计学意义(P>0.05)。结论人工TKA术中使用PRP可减少失血量,利于创口愈合,加快术后早期功能锻炼,同时不增加术后并发症,是一种安全有效的方法。Objective To investigate the therapeutic effects of platelet-rich plasma（ PRP） on reducing bleeding and improving knee joint function in total knee arthroplasty. Methods From January2013 to January 2014,60 patients who met the inclusion criteria were included in the study and underwent total knee arthroplasty. After the application of modified hemostatic methods in the surgery,autologous PRP and blood clotting enzyme were sprayed into the capsule of knee joint in the experimental group（ 30 cases）and the same dose of normal saline and blood clotting enzyme were sprayed in the control group（ 30cases）. The delayed open drainage was applied in both the two groups for 12 h as well as the functional exercises. The operative time,the extent of intraoperative soft tissue lysis,routine blood test results on the2 ndday after the surgery,drainage volume,and the perioperative blood loss were all documented. The postoperative incision inflammatory response, DVT incidences, and deep infection incidences were compared. The time of straight leg raising,the time of active flexion to 90°,and the range of motion of the knee joint in seven,15,90 days after the surgery were also compared. Results Hemoglobin and hematocrit values of the experimental group of the first postoperative two days were significantly higher,while the postoperative drainage and total perioperative blood loss was significantly less than the control group; the differences were statistically significant（ P〈 0. 05）. The time of active flexion to 90° and the active range of motion on the 7thand 15 thday in the experimental group was better than the control group;the differences were statistically significant（ P〈 0. 05）. No significant difference was found between the two groups in terms of operative time, the extent of soft tissue lysis, postoperative platelet count,prothrombin time,activated partial thromboplastin time,the incidences of DVT and deep infection,straight leg raising time,the incision inflammatory response five days after the

关 键 词：富血小板血浆 关节成形术 置换 膝 止血 

分 类 号：R687.4[医药卫生—骨科学]