全膝关节置换中的缺血再灌注损伤  

Ischemia-reperfusion injury in total knee arthroplasty

作　　者：杨毅峰 黄健[1] 叶楠[1] 王琳[1] Yang Yifeng;Huang Jian;Ye Nan;Wang Lin(The Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010000,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古医科大学第二附属医院,内蒙古自治区呼和浩特市010000

出　　处：《中国组织工程研究》2024年第6期955-960,共6页Chinese Journal of Tissue Engineering Research

基　　金：内蒙古医科大学青年项目(YKD2022QN034),项目负责人:杨毅峰;2022年度自治区卫生健康科技计划项目(202201352),项目负责人:黄健。

摘　　要：背景:以往针对缺血再灌注损伤的相关机制、表现、防治已有报道。但对全膝关节置换引起的下肢骨骼肌缺血再灌注损伤研究较少,此文重点对全膝关节置换引起下肢缺血再灌注损伤的发病机制、临床影响及防治方法进行综述。目的:通过对全膝关节置换引起下肢缺血再灌注损伤的相关文献进行归纳总结,分析其机制、意义,为进一步研究骨骼肌缺血再灌注损伤给出提示。方法:应用计算机检索PubMed数据库、CNKI、万方数据库及维普数据库2000-01-01/2022-04-30发表的相关文章,英文检索词为“ischemia-reperfusion injury,total knee arthroplasty,tourniquet,mechanism,pathophysiology,skeletal muscle,treatment”;中文检索词为“缺血再灌注损伤,全膝人工关节置换术,止血带,机制,病理生理,骨骼肌,治疗”。排除重复性研究及部分相关性较低的基础类文章。最终纳入68篇文献进行综述。结果与结论:(1)缺血再灌注损伤的发病机制与氧自由基、细胞内钙超载、中性粒细胞活化相关,还和高浓度一氧化氮、无复流现象以及细胞凋亡等机制相关,更详尽的机制研究能为将来的防治提供依据;(2)下肢缺血再灌注损伤会造成局部骨骼肌损伤,这可能由手术本身的创伤引起,也可能是缺血再灌注损伤的作用,还需要更有针对性的研究区别二者关系;(3)下肢缺血再灌注损伤甚至会影响远端器官,造成肾脏、肺脏损伤,还会影响局部及全身循环;(4)明确缺血再灌注损伤的影响能为将来的防治指明方向,目前的防治措施主要包括缺血预处理,麻醉药物、抗氧化剂等药物预防;(5)针对全膝关节置换手术引起的下肢骨骼肌缺血再灌注损伤的详细综述,能为将来的诊疗决策提供依据。BACKGROUND:The mechanism,manifestation,prevention and treatment of ischemia-reperfusion injury have been reported in the past.However,there are few studies on the ischemia-reperfusion injury of lower limb skeletal muscle caused by total knee arthroplasty.This article focuses on the pathogenesis,clinical impact,prevention and treatment of the ischemia-reperfusion injury of lower limb caused by total knee arthroplasty.OBJECTIVE:To summarize the related literature of lower limb ischemia-reperfusion injury caused by total knee arthroplasty,analyze the mechanism and significance,and give hints for further research on skeletal muscle ischemia-reperfusion injury.METHODS:The relevant articles on PubMed,CNKI,WanFang and VIP databases published from January 1,2000 to April 30,2022 were searched by computer with the Chinese and English search terms of“ischemia-reperfusion injury,total knee arthroplasty,tourniquet,mechanism,pathophysiology,skeletal muscle,treatment”.After excluding repetitive research and some basic articles with low correlation,68 articles were finally selected for review.RESULTS AND CONCLUSION:(1)The pathogenesis of ischemia-reperfusion injury is related to oxygen free radicals,intracellular calcium overload,neutrophil activation,as well as high concentration of nitric oxide,no reflow phenomenon,apoptosis and other mechanisms.More detailed mechanism research can provide basis for future prevention and treatment.(2)Ischemia-reperfusion injury of lower limbs will cause local skeletal muscle injury,which may be caused by the trauma of the operation itself or the role of ischemia-reperfusion injury.More targeted research is needed to distinguish the relationship between the two.(3)Ischemia-reperfusion injury of lower limbs may even affect the distal organs,causing kidney and lung damage.It also affects local and systemic circulation.(4)To clarify the effect of ischemia-reperfusion injury can point out the direction for future prevention and treatment.The current prevention and treatment measures mainly inc

关 键 词：缺血再灌注损伤 全膝关节置换 止血带 机制 病理生理 骨骼肌 治疗 

分 类 号：R459.9[医药卫生—治疗学] R394.2[医药卫生—临床医学] R542.2