术中应用不同假体对全膝关节置换术后引流的影响  

Effects of intraoperative application of different prostheses on postoperative drainage of total knee arthroplasty

作　　者：张明[1] 周殿阁[2] 李志昌[2] Zhang Ming;Zhou Diange;Li Zhichang(Department of Orthopedics,Da Xing Teaching Hospital of Capital Medical University,Beijing,102600;Department of Joint Surgery,Arthritis Clinic&Research Center,Peking University People Hospital,Beijing,100044,China)

机构地区：[1]北京市大兴区人民医院骨科,北京102600 [2]北京大学人民医院关节科,北京100044

出　　处：《生物骨科材料与临床研究》2023年第5期35-39,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨术中使用后方稳定型(posterior cruciate stabilization,PS)与后交叉韧带保留型(posterior cruciate retention,CR)假体对全膝关节置换术(total knee arthroplasty,TKA)术后引流的影响。方法回顾性分析2018年6月至2018年10月终末期骨性关节炎行全膝关节置换的患者102例,其中62例采用后交叉韧带保留型(CR)假体(CR组),40例采用后稳定型(PS)假体(PS组)。所有患者术中均使用止血带、关节腔注射氨甲环酸(tranexamic acid,TXA),术后患肢屈曲1 h、引流管夹毕1 h、患肢冰敷24 h。收集术后2、4、24、48 h引流量和引流液中血红蛋白(hemoglobin,HB)含量,以及术后2、24、48 h静脉血中的血红蛋白(HB)含量。统计术后输血情况、早期感染并发症例数。结果102例患者随访3个月,术后总引流量CR组(292.9±128.3)mL比PS组引流量为(355.2±136.8)mL少,两组比较差异有统计学意义(P<0.05)。术后1 d的CR组的引流量比PS组少,两组比较差异有统计学意义(P<0.05)。术后24 h的CR组引流液中血红蛋白含量比PS组明显下降,两组比较差异有统计学意义(P<0.05)。术后24、48 h的PS组静脉血中血红蛋白含量比CR组明显下降,两组比较差异有统计学意义(P<0.05)。CR组2例输了2 U红细胞,PS组2例输了1 U红细胞、9例输了2 U红细胞。102例患者术后早期均未出现感染并发症。结论与PS假体相比,采用CR假体可减少患者的失血量、术后引流量少、降低全膝关节置换术后贫血的发生、减少围术期输血率。Objective To investigate the effects of application of posterior cruciate stabilization(PS)and posterior cruciate retention(CR)prosthesis on postoperative drainage after total knee arthroplasty(TKA).Methods A retrospective analysis of 102 patients with end-stage osteoarthritis who underwent TKA from June 2018 to October 2018.There were 62 cases using CR,and 40 cases using CR.Tourniquet,articular cavity injection of tranexamic acid(TXA)were used during intraoperation,and limb buckling for 1 h,drainage pipe clamping of an hour,limb cryotherapy for 24 h were used postoperatively for all patients.The hemoglobin(HB)content in the drainage fluid and drainage volume at 2,4,24 and 48 h after surgery were collected.The hemoglobin(HB)content in the venous blood at 2,24 and 48 h after surgery were collected.The cases of blood transfusion and infection were recorded and counted.Results All 102 patients were followed up for 3 months.The total drainage volume of the CR group after surgery was(292.9±128.3)mL less than that of the PS group(355.2±136.8)mL,and the difference was statistically significant(P<0.05).The drainage volume of CR group was less than the PS group on the first day after surgery,and there was statistical difference between the two groups(P<0.05).The hemoglobin content in the drainage fluid of the CR group was significantly less(P<0.05)than that of the PS group at 24 h after surgery.At 24 and 48 hours after surgery,the hemoglobin content in venous blood of the PS group decreased significantly(P<0.05)compared with the CR group.Two cases were transfused with 2 U erythrocytes in the CR group,while two patients were transfused with 1 U erythrocytes and nine patients were transfused with 2 U erythrocytes in the PS group.No infectious complications occurred in 102 patients in the early postoperative period.Conclusion Compared with PS prosthesis,the use of CR prosthesis can reduce the blood loss of patients,reduce the postoperative drainage volume,reduce the occurrence of anemia after TKA,and reduce the postoperati

关 键 词：后方稳定型假体 后交叉韧带保留型假体 全膝关节置换术 术后引流 

分 类 号：R684.3[医药卫生—骨科学] R687.4[医药卫生—外科学]