糖尿病对膝关节置换术失血及早期疗效的影响  

Impact of diabetes mellitus on perioperative blood loss and early clinical outcomes of total knee arthroplasty

作　　者：丁罗宾[1] 赵佳[2] 关健[1] 李锋[1] 聂喜增[1] 谢磊[1] 王华军[3] 郑小飞 梁兴森[4] DING Luo-bin;ZHAO Jia;GUAN Jian;LI Feng;NIE Xi-zeng;XIE Lei;WANG Hua-jun;ZHENG Xiao-fei;UANG Xingsen(Department of Orthopedics,Third Hospital of Shijiazhuang City,Shijiazhuang,050000,China;Hebei Blood Center,Shijiazhuang,050071,China;Department of Orthopedics,the First Affiliated Hospital of Jinan University,Guangzhou 510630,China;Department of Rehabilitation Medicine,The Second People's Hospital of Guangdong Province,Guangdong 510317,China)

机构地区：[1]石家庄市第三医院关节外科,石家庄050000 [2]河北省血液中心配型科,石家庄050071 [3]暨南大学附属第一医院,广州市510630 [4]广东省第二人民医院康复医学科,广东广州510317

出　　处：《中国矫形外科杂志》2019年第11期961-965,共5页Orthopedic Journal of China

基　　金：中国博士后科学基金资助项目(编号:2015M582480,2017T100660);广东省自然科学基金项目(编号:2016A030313100);国家自然科学基金项目(编号:81601219)

摘　　要：[目的]探讨糖尿病(DM)对初次全膝关节置换术围手术期失血量及术后功能康复的影响。[方法]回顾总结在本院行初次TKA治疗且符合纳入标准的膝骨关节炎病例269例,归为糖尿病组114例,非糖尿病组155例。比较两组围手术期失血量、住院时间、VAS评分等,采用HSS评分评价两组患者的术后功能。[结果]术后3 d糖尿病组的Hb及Hct均显著低于非糖尿病组(P<0.05),糖尿病组的显、隐性失血量及理论总失血量均多于非糖尿病组,差异有统计学意义(P<0.05)。糖尿病组病例住院时间显著长于非糖尿病组(P<0.05)。术后3 d时糖尿病组VAS评分和患肢肿胀程度均大于非糖尿病组,差异有统计学意义(P<0.05)。术后4周时糖尿病组HSS评分显著低于非糖尿病组(P<0.05),但术后12周时两组间差异无统计学意义(P>0.05)。所有患者均无切口感染、症状性肺栓塞等并发症。[结论] DM可使TKA围手术期出血量增加,并延缓术后功能恢复。[Objective] To explore the effect of diabetes mellitus(DM) on the perioperative blood loss and early clinical outcomes of primary total knee arthroplasty(TKA).[Methods] A retrospective study was conducted on 209 patients who underwent primary TKA for knee osteoarthritis. Of them, 114 patients were definitely diagnosed of DM(the DM group), while the remaining 155 patients were of non-DM. The perioperative blood loss, hospital stay and visual analogue scale(VAS) for pain were compared between the 2 groups, additionally, HSS score was used for evaluation of clinical consequences.[Results] At 3 days after operation, the DM group had significantly lower Hb and Hct than the non-DM group(P<0.05). In addition, the DM group had significantly greater perioperative blood loss than the non-DM group, including the dominant, the hidden and theoretical total blood loss(P<0.05). Furthermore, the DM group spent significantly longer hospital stay than the non-DM group(P<0.05). Moreover, the DM group took significantly higher VAS and severer swelling than the non-DM group at 3 days postoperatively(P<0.05). Although no a statistically significant difference in HSS score was proved between the two groups at 12 weeks postoperatively(P>0.05), the DM group had significant lower HSS score than the non-DM group at 4 weeks postoperatively(P<0.05). No serious complications, such as incision infection and symptomatic pulmonary embolism, happened in any patient of the two groups.[Conclusion] The DM does increase blood loss perioperatively, and delay functional recovery after TKA.

关 键 词：膝骨关节炎 糖尿病 全膝关节置换 失血量 早期结果 

分 类 号：R687.4[医药卫生—骨科学] R619.1[医药卫生—外科学]