84年鼠女哪年财运最旺,857comvvv色九欧美激情|85PO_87国产精品欲av国产av资源

[1]周紅星,易偉國,張保健,等.止血帶在膝關節(jié)內(nèi)側(cè)間室骨關節(jié)炎初次單髁置換術中的應用[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.
點擊復制

止血帶在膝關節(jié)內(nèi)側(cè)間室骨關節(jié)炎初次單髁置換術中的應用()
分享到：

《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
關鍵詞:
骨關節(jié)炎; 膝;  關節(jié)成形術; 置換; 膝;  止血帶;  臨床試驗
Keywords:
osteoarthritis; knee;  arthroplasty; replacement; knee;  tourniquets;  clinical trial
摘要:
目的:觀察止血帶在膝關節(jié)內(nèi)側(cè)間室骨關節(jié)炎初次單髁置換術中的應用價值及安全性。方法:采用隨機數(shù)字表將符合要求的90例膝關節(jié)內(nèi)側(cè)間室骨關節(jié)炎患者隨機分為止血帶組和無止血帶組,每組45例。2組患者均行膝關節(jié)單髁置換術,術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組患者的手術時間、膝關節(jié)疼痛視覺模擬量表(visual analogue scale,VAS)評分、美國膝關節(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發(fā)生情況。結果:①手術時間。止血帶組的手術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。止血帶組術中出現(xiàn)下肢疼痛3例、松止血帶后血壓下降38例,術后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,術后48 h出現(xiàn)大腿疼痛1例。③膝關節(jié)疼痛VAS評分。時間因素與分組因素不存在交互效應(F=23.846,P=0.170); 2組患者膝關節(jié)疼痛VAS評分比較,組間差異無統(tǒng)計學意義,即不存在分組效應(F=10.589,P=0.543); 手術前后不同時間點之間膝關節(jié)疼痛VAS評分的差異有統(tǒng)計學意義,即存在時間效應(F=14.286,P=0.000); 2組患者膝關節(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(F=29.642,P=0.080); 2組患者KSS評分比較,組間差異無統(tǒng)計學意義,即不存在分組效應(F=15.637,P=0.642); 手術前后不同時間點之間KSS評分的差異有統(tǒng)計學意義,即存在時間效應(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。結論:在膝關節(jié)內(nèi)側(cè)間室骨關節(jié)炎初次單髁置換術中使用止血帶,能縮短手術時間,并發(fā)癥少,雖然術后會發(fā)生不同程度的止血帶反應,但對膝關節(jié)疼痛緩解和膝關節(jié)功能恢復無明顯影響。
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.

參考文獻/References:

[1] KRISTENSEN P W,HOLM H A,VARNUM C.Up to 10-year follow-up of the oxford medial partial knee arthroplasty-695 cases from a single institution[J].J Arthroplasty,2013,28(9 Suppl):195-198. [2] 周友龍,陳奇,康一凡,等.小切口單髁置換術治療膝關節(jié)內(nèi)側(cè)間室骨性關節(jié)炎的早期療效觀察[J].中國骨與關節(jié)損傷雜志,2013,28(8):716-718. [3] MCALINDON T E,BANNURU R R,SULLIVAN M C,et al.OARSI guidelines for the non-surgical management of knee osteoarthritis[J].Osteoarthritis Cartilage,2014,22(3):363-388. [4] KHOKHAR A,CHARI A,MURRAY D,et al.Venous thromboembolism and its prophylaxis in elective knee arthroplasty:an international perspective[J].Knee,2013,20(3):170-176. [5] 蔣協(xié)遠,王大偉.骨科臨床療效評價標準[M].北京:人民衛(wèi)生出版社,2005:123-124. [6] MARTIMBIANCO A L,CALABRESE F R,IHA L A,et al.Reliability of the “American Knee Society Score”(AKSS)[J].Acta Ortop Bras,2012,20(1):34-38. [7] 蘇曉川,郭艷幸,滕軍燕,等.平樂筋骨痛消膏外敷結合肌筋活化治療膝骨關節(jié)炎[J].中醫(yī)正骨,2017,29(11):58-59. 中醫(yī)正骨2019年4月第31卷第4期 J Trad Chin Orthop Trauma,2019,Vol.31,No.4(總275) (總276)中醫(yī)正骨2019年4月第31卷第4期 J Trad Chin Orthop Trauma,2019,Vol.31,No.4 [8] 陳煜東,魏瑄,劉宏建.單髁置換術治療老年膝關節(jié)內(nèi)側(cè)間室骨關節(jié)炎[J].中醫(yī)正骨,2018,30(6):67-69. [9] 郭馬瓏,崔宏勛,李峰,等.單髁置換術治療中重度膝關節(jié)單間室骨關節(jié)炎[J].中醫(yī)正骨,2017,29(6):16-19. [10] ZHANG Q D,GUO W S,ZHANG Q,et al.Comparison between closed suction drainage and nondrainage in total knee arthroplasty:a mata-analysis[J].J Arthroplasty,2011,26(8):1265-1276. [11] KRYCH A J,REARDON P,SOUSA P,et al.Unicompartmental knee arthroplasty provides higher activity and durability than Valgus-Producing proximal tibial osteotomy at 5 to 7 years[J].J Bone Joint Surg Am,2017,99(2):113-122. [12] 白玉明,張海森,劉暢,等.脛骨高位截骨術治療單純內(nèi)側(cè)間室膝骨關節(jié)炎術后炎性細胞因子水平變化研究[J].中國修復重建外科雜志,2017,31(4):422-426. [13] 崔黎明,李強.脛骨高位截骨結合關節(jié)鏡治療膝內(nèi)側(cè)骨關節(jié)炎[J].醫(yī)學理論與實踐,2015,28(16):2197-2198. [14] LIM J W,COUSINS G R,CLIFT B A,et al.Oxford unicompartmental knee arthroplasty versus age and gender matched total knee arthroplasty - functional outcome and survivorship analysis[J].J Arthroplasty,2014,29(9):1779-1783. [15] PANDIT H,JENKINS C,GILL H S,et al.Unnecessary contraindications for mobile-bearing unicompartmental knee replacement[J].J Bone Joint Surg Br,2011,93(5):622-628. [16] COSTA A J,LUSTIG S,SCHOLES C J,et al.Can tibial coverage in total knee replacement be reliably evaluated with three-dimensional image-based digital templating?[J].Bone Joint Res,2013,2(1):1-8. [17] 楊偉銘,曹學偉,趙彩瓊.單髁置換術治療膝關節(jié)內(nèi)側(cè)間室骨關節(jié)炎短期臨床觀察[J].中國中醫(yī)骨傷科雜志,2018,26(4):40-44. [18] 楊偉銘,曹學偉.膝關節(jié)自發(fā)性骨壞死的研究進展[J].中國中醫(yī)骨傷科雜志,2017,25(2):79-82. [19] HUANG Z Y,PEI F X,MA J,et al.Comparison of three different tourniquet application atrategies for minimally invasive total knee arthroplasty:a prospective non-randomized clinical trial[J].Arch Othop Trauma Sur,2014,134(4):561-570. [20] 王剛,曹曉瑞,陳曉勇,等.膝關節(jié)置換術中止血帶的使用對術后加速康復的影響[J].中華骨與關節(jié)外科雜志,2017,10(1):27-32. [21] OSTMAN B,MICHAELSSON K,RAHME H,et al.Tourniquet-induced ischemia and reperfusion in human skeletal muscle[J].Clin Orthop Relat Res,2004,(418):260-265.

相似文獻/References:

[1]樊慶陽,任凱晶.定制3D打印切模輔助全膝關節(jié)置換術治療 膝骨關節(jié)炎合并股骨干骨折畸形愈合[J].中醫(yī)正骨,2015,27(11):37.
[2]劉曉雅,孫永強,劉國杰.主動快速康復鍛煉對全膝關節(jié)置換術后關節(jié)活動度的影響[J].中醫(yī)正骨,2015,27(09):73.
[3]鄭春松,葉蕻芝,李西海,等.透骨消痛膠囊中補腎柔肝藥和活血祛風藥治療 骨關節(jié)炎作用方式的計算機模擬比較[J].中醫(yī)正骨,2015,27(07):6.
　ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Comparison of the mode of action of Bushen Rougan(補腎柔肝)drugs versus Huoxue Qufeng(活血祛風)drugs contained in Tougu Xiaotong Jiaonang(透骨消痛膠囊)for the treatment of osteoarthritis:A computer simulation study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):6.
[4]宋兵華,孫俊英,倪增良,等.全膝關節(jié)置換術前CT測量股骨后髁角的臨床意義[J].中醫(yī)正骨,2015,27(07):38.
[5]鄭春松,葉蕻芝,李西海,等.獨活寄生湯含藥血清對白細胞介素1β誘導的 退變關節(jié)軟骨細胞中基質(zhì)金屬蛋白酶 和環(huán)氧化酶2表達的影響[J].中醫(yī)正骨,2015,27(12):1.
　ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Impact of Duhuo Jisheng Tang(獨活寄生湯)medicated serum on expression of matrix metalloproteinase and cyclooxygenase 2 in degenerative articular chondrocytes induced by interleukin-1 beta[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):1.
[6]王金良,孫京濤,李玲,等.骨水泥聯(lián)合螺釘修復全膝關節(jié)置換術中 脛骨平臺內(nèi)側(cè)骨缺損[J].中醫(yī)正骨,2015,27(12):55.
[7]馮榮,王平,李炳奇,等.鈹針刺絡拔罐結合中藥口服治療膝骨關節(jié)炎合并 原發(fā)性血小板增多癥1例[J].中醫(yī)正骨,2015,27(12):73.
[8]蔡云仙.圍手術期耳穴按壓聯(lián)合平衡針療法 在全膝關節(jié)置換術后鎮(zhèn)痛中的應用[J].中醫(yī)正骨,2015,27(06):41.
[9]張榮,王健.人工全膝關節(jié)置換術的圍手術期心理護理[J].中醫(yī)正骨,2015,27(05):77.
[10]喻長純,楊明路,王戰(zhàn)朝.不同手術方式治療脛骨平臺骨折畸形愈合的體會[J].中醫(yī)正骨,2015,27(03):37.
[11]孟維娜,明立功,王新德,等.關節(jié)鏡下清理聯(lián)合腓骨近1/3段截骨治療膝骨關節(jié)炎[J].中醫(yī)正骨,2015,27(11):40.
[12]明立功,孟維娜,王新德,等.腓骨近端截骨治療內(nèi)側(cè)間室膝骨關節(jié)炎的近期療效觀察[J].中醫(yī)正骨,2015,27(10):25.
[13]張杰,王人彥,張玉柱.膝骨關節(jié)炎的治療進展[J].中醫(yī)正骨,2015,27(10):68.
[14]梁朝,蔡靜怡,閆立,等.針刀療法改善膝骨關節(jié)炎早期疼痛癥狀的療效評價[J].中醫(yī)正骨,2015,27(09):9.
　LIANG Zhao,CAI Jingyi,YAN Li,et al.Evaluation of the curative effect of needle-knife therapy for relieving knee pain in patients with early knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):9.
[15]王建武,黨建軍,李強,等.四聯(lián)療法治療膝骨關節(jié)炎[J].中醫(yī)正骨,2015,27(08):44.
[16]劉紅娟,郭會利,郭樹農(nóng).云克聯(lián)合中藥治療膝骨關節(jié)炎的護理[J].中醫(yī)正骨,2015,27(08):75.
[17]陳衛(wèi)衡.探索建立系統(tǒng)的膝骨關節(jié)炎中醫(yī)臨床科研范式 和理論體系[J].中醫(yī)正骨,2015,27(07):1.
[18]帥波,沈霖,楊艷萍,等.加味青娥丸治療膝骨關節(jié)炎的作用機制研究[J].中醫(yī)正骨,2015,27(07):15.
　SHUAI Bo,SHEN Lin,YANG Yanping,et al.Study on the mechanism of action of Jiawei Qing'e Wan(加味青娥丸)for the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):15.
[19]梅其杰,袁長深,段戡,等.壯藥骨痹方燙熨聯(lián)合運動療法治療膝骨關節(jié)炎的臨床研究[J].中醫(yī)正骨,2015,27(07):27.
　MEI Qijie,YUAN Changshen,DUAN Kan,et al.Clinical study of the curative effect of hot compressing and rubbing with packet of Gubi Fang(骨痹方)combined with exercise therapy in the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):27.
[20]王丹輝,張燕,劉麗娟,等.重組人Ⅱ型腫瘤壞死因子受體-抗體融合蛋白 關節(jié)腔注射聯(lián)合中藥薰洗治療膝骨關節(jié)炎的臨床研究[J].中醫(yī)正骨,2015,27(07):31.
　WANG Danhui,ZHANG Yan,LIU Lijuan,et al.Clinical study on intra-articular injection of TypeⅡrecombinant human tumor necrosis factor receptor-Fc fusion protein combined with Chinese herbal steaming and washing therapy for treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):31.

備注/Memo

備注/Memo:
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