人工关节外科非计划二次手术的分析及对策  

Clinical analysis of the patients underwent unplanned reoperation in arthroplasty surgery

作　　者：翁习生[1] 梁锦前[1] 林进[1] 金今[1] 钱文伟[1] 冯宾[1] 王玮[1] 范彧[1] 

机构地区：[1]北京协和医院骨科,100032

出　　处：《骨科临床与研究杂志》2017年第4期211-214,共4页Journal Of Clinical Orthopedics And Research

基　　金：首都市民健康项目培育(E141100002114047)~~

摘　　要：目的探讨人工关节外科非计划二次手术的发生概率及原因,为人工关节外科非计划二次手术的预防提供参考依据。方法通过住院电子病案系统对2012年1月至2016年6月北京协和医院骨科关节病房住院患者的病例信息进行检索,对其中非计划二次手术的病例进行全面分析。结果本研究纳入人工关节外科手术病例2 941例,其中发生非计划二次手术24例,发生率为0.81%。发生非计划二次手术患者的平均年龄为61.67岁,其中男9例,女15例。患者平均住院天数为44.58 d。经描述性分析发现,术后感染、切口愈合不良、假体脱位是发生非计划二次手术的主要原因,分别占29.2%(7/24)、20.8%(5/24)、25.0%(6/24)。结论合并高血压、糖尿病、血友病以及因类风湿关节炎等免疫系统疾病长期服用免疫抑制剂或糖皮质激素是发生非计划二次手术的高危因素。建议在完善术前检查和相关科室会诊的同时,术前应当与患者及家属进行充分宣教及沟通,告知可能出现的非计划二次手术的风险。Objective To provide the precautionary measures by investigating the incidence and the reasons of unplanned reoperation in patients underwent arthroplasty surgery. Methods To retrieve the cases in-formation in the Department of Orthopedic Surgery of Peking Union Medical College Hospital from January 2012 to June 2016 through the electronic medical record system. A comprehensive analysis of the cases of unplanned reoperation after arthroplasty surgery was completed. Results During the study period, arthroplasty surgery were performed in 2 941 cases, in which the unplanned reoperation occurred in 24 cases with the total incidence rate of 0. 81%. The average age of unplanned reoperation patients was 61.67 years. There were 9 males and 15 females. The average total length of hospital stay was 44. 58 days. Postoperative infection, poor wound healing and dislocation of the prosthesis were the main causes of unplanned reoperation, accounted for 29.2% （ 7 /2 4 ） , 20. 8% （ 5/24） and 25% （ 6/24） respectively. Conclusion The associated hypertension, diabetes, hemophilia and long-term use of immunosuppressive drugs or corticosteroids are risk factors of the unplanned reoperation. Recommendations such as comprehensive preoperative examination and related departments consultation should be performed. High risk patients and their families should be emphasized for the risk of unplanned reoperation befor the arthroplasty surgery.

关 键 词：人工关节 再手术 手术后并发症 危险因素 

分 类 号：R687.4[医药卫生—骨科学]