本文選題：骨關節(jié)炎 + 全膝關節(jié)置換術�。� 參考：《浙江大學》2015年博士論文

【摘要】：研究目的：研究全膝關節(jié)置換術中全程和前半程使用止血帶對患者術后早期康復效果的影響。 研究方法：選擇2014年6月1日至2015年1月31日于浙江大學醫(yī)學院附屬第二醫(yī)院入院和出院主診斷均為左(或右)膝骨關節(jié)炎,并且初次行全膝關節(jié)置換術,術中分別為全程和前半程使用止血帶的患者各40名,依據(jù)住院病歷系統(tǒng)的資料進行回顧性研究。對兩組患者的手術時間,術中失血量、圍手術期輸血率、材料費用、術后住院時間、實驗室檢查、紅細胞丟失量以及術后嚴重并發(fā)癥的發(fā)生率等系列指標進行對比分析。 研究結(jié)果：與全程使用止血帶相比,前半程組的劣勢主要有延長手術時間(68.68±10.73v.s.87.65±11.45min;P0.001),也增加了術中失血量(97.88±39.89v.s.127.50±49.29mL;P=0.004).它的優(yōu)勢主要有減少總紅細胞丟失量(53.73±147.38v.s.344.51±125.88mL；P=0.017)和隱性紅細胞丟失量(310.40±137.68v.s.215.13±119.31mL;P=0.025),縮短了術后住院時間(9.60±3.42v.s.7.05±2.89天；P=0.001),并且患者術后下肢關節(jié)功能恢復器的輔助彎曲角度可以更快達到90。(4.74±1.69v.s.4.00±1.11天；P=0.028)。兩組患者在圍手術期輸血率、顯性紅細胞丟失量上無顯著性差異。 研究結(jié)論：全膝關節(jié)置換術中止血帶的應用已經(jīng)被眾多關節(jié)外科醫(yī)生所接受,在創(chuàng)口縫合之前釋放止血帶進行止血,不僅能減少患者圍手術期失血量,還縮短住院時間,有利于患者早期功能鍛煉,同時不會增加血管栓塞及術后嚴重感染等并發(fā)癥的發(fā)生率。
[Abstract]:Objective: to study the effect of tourniquet on early postoperative rehabilitation after total knee arthroplasty. Methods: from June 1, 2014 to January 31, 2015, the main diagnosis of left (or right) knee osteoarthritis was performed at the second affiliated Hospital of Zhejiang University School of Medicine, and total knee arthroplasty was performed for the first time. A retrospective study was carried out in 40 patients using tourniquet during the whole and the first half of the operation, respectively, according to the data of the inpatient medical record system. The operation time, intraoperative blood loss, perioperative blood transfusion rate, material cost, postoperative hospitalization time, laboratory examination, red blood cell loss and the incidence of severe postoperative complications were compared and analyzed between the two groups. Results: compared with the whole course of tourniquet use, the main disadvantages of the first half group were to prolong the operation time (68.68 鹵11.45min) P0.001a, and to increase the blood loss during operation (97.88 鹵49.29mL / P 0.004). The main advantages were to reduce the total RBC loss (53.73 鹵125.88mLP0.017) and occult RBC loss (310.40 鹵119.31mLP0. 025), which shortened the postoperative hospitalization time (9.60 鹵3.42v.s.7.05 鹵2.89 days), and the auxiliary bending angle of the lower limb joint function restorer could reach 90.0.4.74 鹵1.11 days P0.028. There was no significant difference in blood transfusion rate and dominant red blood cell loss between the two groups during perioperative period. Conclusion: the application of tourniquet in total knee arthroplasty has been accepted by many joint surgeons. The release of tourniquet before suture of the wound can not only reduce the amount of blood loss in perioperative period, but also shorten the length of hospital stay. It is beneficial to early functional exercise and does not increase the incidence of complications such as vascular embolism and severe postoperative infection.
【學位授予單位】：浙江大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R687.4

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