下肢动脉粥样硬化对全膝关节置换术早期结果的影响  

Effect of lower extremity atherosclerosis on early outcomes of total knee arthroplasty

作　　者：杨波[1] 王腾云 吴长坤[2] 缪伟[3] 姜鑫[1] YANG Bo;WANG Teng-yun;WU Chang-kun;MIAO Wei;JIANG Xin(Department of Joint Surgery,Weifang People＇s Hospital,Weifang 261041,China;Clinical Medical College,Weifang Medical University,Weifang 261042,China;Department of Ultrasonography,Weifang People＇s Hospital,Weifang 261041,China)

机构地区：[1]潍坊市人民医院关节外科,261042 [2]潍坊医学院临床医学院,261041 [3]潍坊市人民医院超声科,261042

出　　处：《中国矫形外科杂志》2018年第21期1947-1951,共5页Orthopedic Journal of China

摘　　要：[目的]评价经彩超诊断的下肢动脉粥样硬化对全膝关节置换术(TKA)早期结果的影响。[方法]回顾分析2017年1月-10月收治并符合纳入标准的353例(387膝) TKA患者,按照术前下肢动脉彩超诊断结果分为正常组151膝和病变组236膝,病变组下肢动脉彩超诊断动脉粥样硬化。所有病例在半程止血带下行TKA。术后比较两组切口并发症、VTE发病率。[结果]病变组的年龄显著高于正常组,两组比较差异有统计学意义(P<0.05),提示年龄增加血管病变的发生也增加。两组中性别构成差异有统计学意义(P<0.05),提示男性患者下肢动脉粥样硬化发病率较女性高。两组间并存高血压病、高脂血症、糖尿病和冠状动脉粥样硬化性心脏病的差异无统计学意义(P>0.05)。术后早期两组切口并发症、VTE发病率差异均无统计学意义(P>0.05)。但合并糖尿病患者术后切口并发症发病率更高(P<0.05)。[结论]经彩超诊断的下肢动脉粥样硬化患者行TKA术是安全的,未增加术后切口并发症、VTE风险。糖尿病是术后切口并发症的独立风险因素。[Objective] To determine the effect of lower extremity atherosclerosis verified by ultrasonography on early outcomes of total knee arthroplasty（TKA）. [Methods]Between January and October, 2017, 353 patients（387 knees） who underwent primary TKA were retrospectively reviewed. According to the results of preoperative arterial ultrasonography, 151 knees without lower extremity atherosclerosis were enrolled into the normal group, while 236 knees with symptomless atherosclerosis lesion revealed by ultrasonography were termed as disease group. All the patients had TKA performed under half-course tourniquet. The incidences of incision complication and venous thromboembolism（VTE） were compared between the two groups. [Results] The disease group proved significantly older in age than the normal group（P〈0.05）, which implied that the incidence of atherosclerosis increased as the age increased. In addition, there was a significant difference between two genders, the males was more prone to atherosclerosis than the females（P〈0.05）. However, there were no significant differences regarding to coexisting diseases including hypertension, hyperlipemia, diabetes mellitus and coronary artery disease between the normal and the disease group（P〈0.05）. In term of early complications after TKA, no significant differences in incision problems and VTE were noticed between them（P〉0.05）. Nevertheless, the patients who coexisted diabetes mellitus had significantly higher chance of incision problems（P〈0.05）. [Conclusion] The TKA is safe operation for patients with preexisting lower extremity atherosclerosis, without increasing risks of wound complication and VTE. However, diabetes mellitus is an independent risk factor of incision problems.

关 键 词：下肢动脉粥样硬化 全膝关节置换术 切口并发症 静脉血栓栓塞 

分 类 号：R687.4[医药卫生—骨科学]