膝关节积液状态屈曲角度关节腔内压力变化及对下肢静脉流速影响  

Changes of intra-articular pressure with flexion angle of knee joint effusion and its influence on venous velocity of lower extremities

作　　者：王波 符培亮 丁喆如 陈宜 钱齐荣 WANG Bo;FU Pei-liang;DING Zhe-ru;CHEN Yi;QIAN Qi-rong(Department of Orthopaedics,The Second Affiliated Hospital of the Naval Military Medical University,Shanghai,200003,China)

机构地区：[1]中国人民解放军海军军医大学第二附属医院骨科,上海200003

出　　处：《中国骨与关节杂志》2023年第3期186-191,共6页Chinese Journal of Bone and Joint

基　　金：上海市申康医院发展中心临床科技创新项目(SHDC12019X14)。

摘　　要：目的 了解不同积液量情况下膝关节屈伸活动时关节腔容积变化及其对下肢静脉血流速度的影响,为个性化调整膝关节置换术后快速康复方案及预防术中术后深静脉血栓提供理论依据。方法 选取我科因半月板损伤行关节镜下半月板成形的患者共20例,术前MRI排除关节积液,通过关节镜穿刺器在彻底抽吸膝关节腔内液体后在伸直状态下关节腔内注入20 ml、50 ml、100 ml生理盐水时关节内压力,然后分别测量膝关节屈曲45°、90°、105°时膝关节压力变化,通过多普勒超声测量膝关节不同积液及屈曲角度时小腿胫后静脉血流速度。使用SPSS软件进行组间比较及相关性分析。结果 本组患者平均身高(166.6±4.8) cm,BMI平均为(26.3±3.4),患者平均年龄44.3岁。患者膝关节注入20 ml生理盐水时在不同角度关节腔内压力分别为0 mm Hg、(5.3±2.1) mm Hg、(20.0±3.2) mm Hg,胫后静脉流速分别为(25.2±2.3) mm/s、(23.8±3.1) mm/s、(23.1±3.5) mm/s,50 ml生理盐水时不同角度关节腔内压力分别为(2.3±1.2) mm Hg、(10.3±3.1) mm Hg、(48.2±3.2) mm Hg,胫后静脉流速分别为(25.1±2.2) mm/s、(23.3±3.5) mm/s、(20.1±2.5) mm/s,100 ml生理盐水时不同角度关节腔内压力分别为(11.3±3.2) mm Hg、(30.3±3.1) mm Hg、(80.3±7.2) mm Hg,胫后静脉流速分别为(24.2±3.2) mm/s、(21.2±2.5) mm/s、(18.1±1.5) mm/s。膝关节腔容积平均为(50.3±5.8) ml,膝关节屈曲时膝关节腔内容积明显下降,积液量超过50 ml时膝关节屈曲过程中关节腔内压力明显增加,当膝关节屈曲超过90°时胫后静脉流速与膝关节伸直位及屈曲45°时流速之间差异有统计学意义。结论 膝关节腔容积随膝关节屈曲角度的增加而减小,当积液量超过50 ml时膝关节屈曲角度增加明显增加膝关节腔压力及胫后静脉流速,全膝关节置换术术后关节腔出血较多肿胀明显时过度训练可能增加下肢深静脉血栓风险,应个性化调�Objective To investigate the changes of intra-articular pressure with flexion angle of knee joint effusion and its impact on venous velocity of lower extremities, aiming to provide theoretical basis for individualized fast recovery plan and the prevention of intraoperative and postoperative deep venous thrombosis. Methods A total of 20 patients in our department, who underwent arthroscopic meniscus formation due to meniscus injury, were selected.The joint effusion was excluded by preoperative MRI. The intra-articular pressure was measured when 20 ml, 50 ml,and 100ml of normal saline was injected, and then the pressure changes of the knee joint were measured when the knee joint was flexed at 45°, 90°, and 105°, respectively. Blood flow velocity in the posterior tibial vein was measured.SPSS software was used for comparison and correlation analysis among groups. Results The average height of the patients in this group was( 166.6 ± 4.8) cm, the average BMI was( 26.3 ± 3.4), and the average age of the patients was 44.3 years. When the knee joint was injected with 20ml saline, the intra-articular pressures at different angles were 0 mm Hg,( 5.3 ± 2.1) mm Hg,( 20.0 ± 3.2) mm Hg, the posterior tibial vein flow rates were( 25.2 ± 2.3) mm/s,( 23.8 ± 3.1) mm/s,( 23.1 ± 3.5) mm/s;the intra-articular pressures at different angles were( 2.3 ± 1.2) mm Hg,( 10.3 ± 3.1) mm Hg,( 48.2 ± 3.2) mm Hg, and the posterior tibial vein flow rates were( 25.1 ± 2.2) mm/s,( 23.3 ± 3.5) mm when 50 ml saline was injected in, respectively;when the knee joint was injected with 100 ml of saline, the intra-articular pressures at different angles were( 11.3 ± 3.2) mm Hg,( 30.3 ± 3.1) mm Hg,( 80.3 ±7.2) mm Hg, and the posterior tibial vein velocity was( 24.2 ± 3.2) mm/s,( 21.2 ± 2.5) mm/s,( 18.1 ± 1.5) mm/s.The average volume of the knee joint cavity was( 50.3 ± 5.8) ml. When the knee joint was flexed, the volume of the knee joint cavity decreased significantly. When the effusion volume exceeded 50 ml, the intra-articular cavit

关 键 词：关节成形术 置换 膝 静脉血栓形成 膝关节 关节腔积液关节腔积液 

分 类 号：R681.8[医药卫生—骨科学]