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[1]周紅星,易偉國,張保健,等.止血帶在膝關(guān)節(jié)內(nèi)側(cè)間室骨關(guān)節(jié)炎初次單髁置換術(shù)中的應(yīng)用[J].中醫(yī)正骨,2019,31(04):31-35.
　ZHOU Hongxing,YI Weiguo,ZHANG Baojian,et al.Application of tourniquets to primary unicompartmental knee arthroplasty for treatment of medial compartment knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(04):31-35.
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止血帶在膝關(guān)節(jié)內(nèi)側(cè)間室骨關(guān)節(jié)炎初次單髁置換術(shù)中的應(yīng)用()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年04期
頁碼:
31-35
欄目:
臨床研究
出版日期:
2019-04-30

文章信息/Info

Title:
Application of tourniquets to primary unicompartmental knee arthroplasty for treatment of medial compartment knee osteoarthritis
作者:
周紅星; 易偉國; 張保健; 蘭宇斌; 成小輝; 王永朝; 姜祖康; 袁祥生
(中國人民解放軍第一五二中心醫(yī)院,河南 平頂山 467000)
Author(s):
ZHOU Hongxing; YI Weiguo; ZHANG Baojian; LAN Yubin; CHENG Xiaohui; WANG Yongchao; JIANG Zukang; YUAN Xiangsheng
The 152nd Central Hospital of PLA,Pingdingshan 467000,Henan,China
關(guān)鍵詞:
骨關(guān)節(jié)炎; 膝;  關(guān)節(jié)成形術(shù); 置換; 膝;  止血帶;  臨床試驗
Keywords:
osteoarthritis; knee;  arthroplasty; replacement; knee;  tourniquets;  clinical trial
摘要:
目的:觀察止血帶在膝關(guān)節(jié)內(nèi)側(cè)間室骨關(guān)節(jié)炎初次單髁置換術(shù)中的應(yīng)用價值及安全性。方法:采用隨機數(shù)字表將符合要求的90例膝關(guān)節(jié)內(nèi)側(cè)間室骨關(guān)節(jié)炎患者隨機分為止血帶組和無止血帶組,每組45例。2組患者均行膝關(guān)節(jié)單髁置換術(shù),術(shù)中止血帶組大腿根部上氣壓止血帶,無止血帶組不上止血帶。記錄并比較2組患者的手術(shù)時間、膝關(guān)節(jié)疼痛視覺模擬量表(visual analogue scale,VAS)評分、美國膝關(guān)節(jié)協(xié)會評分(knee society score,KSS)及并發(fā)癥發(fā)生情況,并觀察止血帶組止血帶反應(yīng)發(fā)生情況。結(jié)果:①手術(shù)時間。止血帶組的手術(shù)時間短于無止血帶組[(61.00±3.24)min,(70.00±2.87)min,t=4.854,P=0.002]。②止血帶反應(yīng)。止血帶組術(shù)中出現(xiàn)下肢疼痛3例、松止血帶后血壓下降38例,術(shù)后6 h出現(xiàn)下肢疼痛2例、大腿疼痛15例、下肢麻木17例、大腿根部張力性水皰1例,術(shù)后24 h出現(xiàn)大腿疼痛8例、下肢麻木2例、大腿根部張力性水皰8例,術(shù)后48 h出現(xiàn)大腿疼痛1例。③膝關(guān)節(jié)疼痛VAS評分。時間因素與分組因素不存在交互效應(yīng)(F=23.846,P=0.170); 2組患者膝關(guān)節(jié)疼痛VAS評分比較,組間差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=10.589,P=0.543); 手術(shù)前后不同時間點之間膝關(guān)節(jié)疼痛VAS評分的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=14.286,P=0.000); 2組患者膝關(guān)節(jié)疼痛VAS評分隨時間均呈降低趨勢,且2組的降低趨勢完全一致[(6.87±1.01)分,(6.14±1.21)分,(2.34±1.82)分,(1.96±1.34)分,(1.35±0.73)分,F=1.162,P=0.000;(7.03±1.24)分,(5.87±1.57)分,(2.41±1.65)分,(2.08±1.25)分,(1.24±0.68)分,F=8.023,P=0.000]。④KSS評分。時間因素與分組因素不存在交互效應(yīng)(F=29.642,P=0.080); 2組患者KSS評分比較,組間差異無統(tǒng)計學(xué)意義,即不存在分組效應(yīng)(F=15.637,P=0.642); 手術(shù)前后不同時間點之間KSS評分的差異有統(tǒng)計學(xué)意義,即存在時間效應(yīng)(F=31.345,P=0.000); 2組患者KSS評分隨時間均呈增加趨勢,且2組的增加趨勢完全一致[(35.4±4.61)分,(52.6±5.16)分,(73.7±4.81)分,(85.6±5.32)分,(89.2±4.29)分,F=34.284,P=0.000;(34.9±5.82)分,(51.4±4.85)分,(72.9±5.03)分,(84.9±4.86)分,(90.1±3.53)分,F=40.129,P=0.000]。⑤安全性。2組患者均無下肢深靜脈血栓形成、假體組件移位、假體周圍骨折等并發(fā)癥發(fā)生。結(jié)論:在膝關(guān)節(jié)內(nèi)側(cè)間室骨關(guān)節(jié)炎初次單髁置換術(shù)中使用止血帶,能縮短手術(shù)時間,并發(fā)癥少,雖然術(shù)后會發(fā)生不同程度的止血帶反應(yīng),但對膝關(guān)節(jié)疼痛緩解和膝關(guān)節(jié)功能恢復(fù)無明顯影響。
Abstract:
Objective:To explore the applied values and safety of tourniquets in primary unicompartmental knee arthroplasty(UKA)for treatment of medial compartment knee osteoarthritis(KOA).Methods:Ninety patients with medial compartment KOA were enrolled in the study and were randomly divided into tourniquet group and non-tourniquet group by using random digits table,45 cases in each group.All patients in the 2 groups were treated with UKA,and the pneumatic tourniquets were applied to patients of tourniquet group at thigh root in the surgery,while no pneumatic tourniquets were applied to patients of non-tourniquet group.The operative time,knee pain visual analogue scale(VAS)scores,American knee society scores(KSS)and complications were recorded and compared between the 2 groups respectively,and the tourniquet reactions were observed in tourniquet group.Results:The operative time was shorter in tourniquet group compared to non-tourniquet group(61.00+/-3.24 vs 70.00+/-2.87 min,t=4.854,P=0.002).The lower limbs pain(3)and drop of blood pressure after releasing the tourniquet(38)were found during the surgery in patients of tourniquet group.The lower limbs pain(2),thigh pain(15),lower limb numbness(17)and tension blisters at the root of thigh(1)were found at postoperative hour 6.The thigh pain(8),lower limb numbness(2)and tension blisters at the root of thigh(8)were found at postoperative hour 24,and thigh pain(1)was found at postoperative hour 48.There was no interaction between time factor and group factor in knee pain VAS scores(F=23.846,P=0.170).There was no statistical difference in knee pain VAS scores between the 2 groups,in other words,there was no group effect(F=10.589,P=0.543).There was statistical difference in knee pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=14.286,P=0.000).The knee pain VAS scores presented a time-dependent decreasing trend in both of the 2 groups,and the 2 groups were consistent with each other in the decreasing trend of knee pain VAS scores(6.87+/-1.01,6.14+/-1.21,2.34+/-1.82,1.96+/-1.34,1.35+/-0.73 points,F=1.162,P=0.000; 7.03+/-1.24,5.87+/-1.57,2.41+/-1.65,2.08+/-1.25,1.24+/-0.68 points,F=8.023,P=0.000).There was no interaction between time factor and group factor in KSS scores(F=29.642,P=0.080).There was no statistical difference in KSS scores between the 2 groups,in other words,there was no group effect(F=15.637,P=0.642).There was statistical difference in KSS scores between different timepoints before and after the treatment,in other words,there was time effect(F=31.345,P=0.000).The KSS scores presented a time-dependent increasing trend in both of the 2 groups,and the 2 groups were consistent with each other in the increasing trend of KSS scores(35.4+/-4.61,52.6+/-5.16,73.7+/-4.81,85.6+/-5.32,89.2+/-4.29 points,F=34.284,P=0.000; 34.9+/-5.82,51.4+/-4.85,72.9+/-5.03,84.9+/-4.86,90.1+/-3.53 points,F=40.129,P=0.000).No complications such as lower extremity deep venous thrombosis,prosthetic components displacement and peri-prosthetic fracture were found in both of the 2 groups.Conclusion:Application of tourniquets can shorten the operation time in primary UKA for treatment of medial compartment KOA with few complications.Although tourniquet reactions at different degrees may occur after the surgery,they have no obvious effect on knee pain relief and knee function recovery.

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通訊作者:易偉國 E-mail:[email protected](收稿日期:2018-12-02 本文編輯:時紅磊)
更新日期/Last Update: 2019-10-08