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骨性关节炎全膝关节置换术中切除滑膜对失血量及膝关节功能的影响
何云利,张乾,张杭
0
天津市北辰医院骨关节科(天津 300400)
摘要:
探讨骨性关节炎全膝关节置换术中切除滑膜对失血量和膝关节功能的影响。方法:选取初次骨性关节炎全膝关节置换术患者180例,随机分成观察组和对照组各90例。观察组在全膝关节置换手术中切除滑膜,对照组保留滑膜,观察两组手术失血量、手术时间、和手术前后的疼痛情况以及术后膝关节临床和功能评分。结果:观察组手术显性失血量(750.9±253.7)mL、隐性出血量(722.8±213.3)mL、理论总出血量(1557.2±346.8)mL和手术时间(111.3±23.9)min均明显高于对照组显性失血量(543.2±223.6)mL、隐性失血量(536.1±192.4)mL、理论总失血量(1086.7±242.9)mL和手术时间(90.6±20.2)min(P<0.05);两组手术后3 d、12周和1年时的VAS评分均明显低于手术前,差异均有统计学意义(P<0.05);但两组间比较差异无统计学意义(P>0.05);两组术后12周和术后1年美国膝关节协会评分标准(AKSS)临床评分和功能评分比较,差异无统计学意义(P>0.05);观察组术后不良反应和感染发生率为11.11%,对照组3.33%(P<0.05)。结论:骨性关节炎全膝关节置换术中切除滑膜,可明显增加失血量和感染风险,但未能显著促进膝关节功能改善的作用。
关键词:  全膝关节置换术  滑膜  出血量  膝关节功能
DOI:10.3969/j.issn.1007-6948.2019.01.004
基金项目:
Effect of Synovectomy on Blood Loss and Knee Function in Total Knee Arthroplasty for Osteoarthritis
HE Yun-li,ZHANG Qian,ZHANG Hang
Bone and Joint division, Beichen Hospital, Tianjin City, Tianjin (300400), China
Abstract:
Objective To discuss the effect of synovectomy on blood loss and knee function in total knee arthroplasty for osteoarthritis. Methods The patients with primary osteoarthritis (180 cases) undergoing total knee arthroplasty were selected and randomly divided into observation group and control group, with 90 cases in each group. The patients in observation group underwent synovectomy during total knee arthroplasty but the synovial membrane was preserved in control group. The blood loss, operation time, pain before and after operation, clinical and functional scores of knee joint were observed in both groups. Results In observation group, operative apparent blood loss was (750.9+253.7) mL, occult bleeding volume was (722.8 ±213.3) mL, the theoretical total blood loss was (1557.2 +346.8) mL and operation time was (111.3+23.93) min, which were significantly higher than those of the control group in terms of dominant blood loss (543.2 +223.6 ) mL, recessive blood loss (536.1+192.41) mL, theoretical total blood loss (1086.7+242.9) mL and operation time (90.6+20.2) min (P<0.05). VAS scores at 3 d, 12 weeks and 1 year after operation in both groups were significantly lower than those before operation. The difference was statistically significant (P<0.05). There was no significant difference between the two groups (P>0.05). There was no significant difference in AKSS clinical score and functional score between the two groups 12 weeks after operation and 1 year after operation (P>0.05). The incidence of adverse reactions and infections was 11.11% in the observation group and 3.33% in the control group (P<0.05). Conclusion The removal of synovium in total knee arthroplasty for osteoarthritis can significantly increase blood loss and infection risk, but it can not significantly improve the function of knee joint.
Key words:  Total knee arthroplasty  synovium  blood loss  knee joint function

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