全膝关节置换术后术膝顽固性肿胀积液处理对策  

Countermeasures of intractable swelling and hydrops of knee after total knee arthroplasty

作　　者：侯大标 罗斯敏[2] 查振刚[2] 吴文锐[2] 刘宁[2] 罗东斌 HOU Da-biao;LUO Si-min;ZHA Zhen-gang;WU Wen-rui;LIU Ning;LUO Dong-bin(Department of Orthopedic Surgery,Guangzhou Hospital of Integrated Chinese and Western Medicine,Guangzhou,Guangdong 510800,China;不详)

机构地区：[1]广州市中西医结合医院骨科,广东广州510800 [2]暨南大学附属第一医院骨关节外科,广东广州510630

出　　处：《中国临床研究》2019年第12期1667-1670,共4页Chinese Journal of Clinical Research

基　　金：广东省医学科研基金(A2018299)~~

摘　　要：目的探讨全膝关节置换术后术膝顽固性肿胀积液的治疗方法。方法对2013年6月至2018年12月暨南大学附属第一医院骨关节科进行膝关节置换术术后出现顽固性关节肿胀积液的29例患者进行回顾性分析调查,针对患者术前基本情况、术中所见及术后康复措施等可能引起术膝肿胀积液的原因进行分析,并就治疗效果随访调查。结果 6例术膝活动范围改变不大,VAS疼痛评分仍处于轻度疼痛,予以改换抗生素;5例极早期下地无保护下负重行走,予以床上制动休息,减少关节活动5 d;8例回顾术中打开关节腔出现超过50 ml关节液,予以关节腔抽取积液,注射万古霉素;7例于术前半年反复关节腔注射糖皮质激素,3例术前合并糖尿病,予以保留假体,清创冲洗,更换聚乙烯衬垫。随访6个月,所有病例肿胀无加重,无感染发生。结论根据术前患者基本信息、术中关节腔积液量、术后康复中所遇到的特殊情况来制定不同的处理方案,早期、及时、合理处置,才能更好的预防无法逆转的假体周围感染的发生,为全膝关节置换术保驾护航。Objective To explore the treatment of refractory swelling and hydrops of the knee after total knee arthroplasty(TKA).Methods A retrospective analysis was performed in 29 patients with intractable swelling and hydrops of knee joint,who underwent TKA in the First Affiliated Hospital of Jinan University from June 2013 to December 2018.According to the patients′basic conditions before operation,intraoperative findings and rehabilitation measures after operation,the causes of swelling and hydrops of knee joints were analyzed,and the treatment effect was observed during follow-up period.Results The range of motion of the knee was not changed obviously in 6 cases,and the altered antibiotics were used because of mild pain[visual analog score(VAS)].Five patients walked in the very early postoperative stage without protection and were ordered to bedrest for 5 days to reduce joint activity.In 8 cases,effusion of more than 50 ml depth in the opened joint cavity was extracted,and vancomycin was injected into it during operation.In 7 cases,glucocorticoids were injected into the joint cavity repeatedly half a year before operation.In 3 patients with diabetes mellitus,the joint prosthesis was preserved,and debridement,irrigation and polyethylene liner exchange were conducted.After 6 months of follow-up,no progressive swelling and infections occurred.Conclusion Based on the basic information of patients before operation,the joint effusion during operation and the special circumstances encountered in the postoperative rehabilitation,the different treatment plans can be formulated early,timely and reasonablely so as to better prevent the occurrence of irreversible periprosthetic infection after total knee arthroplasty.

关 键 词：全膝关节置换术 肿胀 顽固性肿胀积液 视觉模拟评分法 

分 类 号：R687.4[医药卫生—骨科学]