不同程度的下肢动脉钙化对全膝关节置换术的伤口并发症分析  

Wound complications analysis of total knee arthroplasty patients with different degrees of vascular calcifications

作　　者：丁冉[1] 史振才[1] 王卫国[1] 郭万首[1] 岳德波[1] 孙伟[1] 程立明[1] 刘朝晖[1] 张念非[1] 王佰亮[1] Ding Ran;Shi Zhencai;Wang Weiguo(Department of Orthopedic Surgery,China-Japan Friendship Hospital,Beijing,100029,China)

机构地区：[1]中日友好医院骨科一部,北京100029

出　　处：《生物骨科材料与临床研究》2018年第3期14-17,共4页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨术前X线提示的血管钙化全膝关节置换术的患者是否会出现伤口缺血等并发症的增加。方法通过回顾性分析2015年1月至2016年12月我院术中应用止血带的初次全膝关节置换术的患者资料,根据术前X线是否存在血管钙化分为三组:内膜钙化、中膜钙化及无钙化组。进行术后缺血相关并发症的相关性分析。结果纳入患者共577膝(437例),其中有96膝合并血管钙化,其中内膜钙化组为74膝(64例),中膜钙化组为22膝(20例)。无一例出现下肢动脉严重缺血并发症,内膜钙化组的浅表伤口愈合不良发生率为5.40%,显著高于中膜钙化组(0%)和无钙化组(1.25%)(P=0.032)。Logistic多因素回归分析结果显示,血管内膜钙化(OR=1.367,95%CI:1.152-1.888)是老年TKA术后伤口缺血并发症的危险因素。结论术前合并内膜钙化组病人的伤口并发症风险显著增加。术前应该充分重视合并血管钙化的病人,围手术期应加强这类病人止血带的规范化使用、术中软组织的保护以及警惕术后下肢动脉缺血并发症。Objective The aim of this study was to discuss whether TKA patients with preexisting radiographic evidence of vascular calcifications had a higher risk of wound ischemic complications. Methods In this retrospective analysis, all patients who had undergone primary TKA in the period 2015 - 2016 with intraoperative use of a tourniquet were included.Vascular calcifications seen on the preoperative radiograph were classified as intimal-type and medial-type calcifications and no calcifications. The correlation analysis of perioperative ischemic complications and calcifications was done. Results There are 437 patients with 577 knees were included. Vascular calcifications were seen in 96 knees（medial type：n =74 knees, 64 patients; intimal type： n=22 knees, 20 patients）. Major ischemic complications such as arterial thrombosis were not seen. The rate of minor ischemic complications such as poor healing of superficial wound was significantly elevated in patients with intimal-type calcifications（5.40%） when compared to patients with medial-type calcifications（0%） and those without（1.25%, P=0.032）. Multiple Logistic regression analysis revealed the factor most associated with the increase risk for ischemic complications was intimal-type calcifications（OR=1.367, 95%CI：1.152-1.888）. Conclusion The rate of minor ischemic complications was obviously elevated in the patient group with intimal artery calcifications. We recommend high alertness to the presence of calcifications on preoperative radiographs.In patients with intimal artery calcifications, standardized application of tourniquet should not be ignored. Intraoperative soft tissue management should be very careful and postoperative vascular status should be monitored closely.

关 键 词：血管钙化 缺血并发症 全膝关节置换术 

分 类 号：R681.8[医药卫生—骨科学]