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
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摘要
目的: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。
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 signi?cantly 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 signi?cantly lower than those before operation. The difference was statistically signi?cant(P<0.05). There was no signi?cant 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 signi?cantly increase blood loss and infection risk, but it can not signi?cantly improve the function of knee joint.
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 signi?cantly 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 signi?cantly lower than those before operation. The difference was statistically signi?cant(P<0.05). There was no signi?cant 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 signi?cantly increase blood loss and infection risk, but it can not signi?cantly improve the function of knee joint.
引文
[1]Hughes KE,Nickel D,Gurney-Dunlop T,et al.Total knee arthroplasty in multiple sclerosis[J].Arthroplast Today,2016,2(3):117-122.
[2]Jones G.Osteoarthritis:where are we for pain and therapy in2013[J].Aust Fam Physician,2013,11(6):766-769.
[3]Seviciu A,Gross I,Fathima S,et al.Effects of tranexamic acid and bipolar sealer alone or in combination in primary total knee arthroplasty:a prospective,randomized,controlled trial[J].Arthroplasty Today,2016,2(2):77-82.
[4]Georgiannos D,Boutsiadis A,Agathangelidis F,et al.Arthroscopically-assisted mini open partial synovectomy for the treatment of localized pigmented villonodular synovitis of the knee.A retrospective comparative study with long-term follow up[J].Int Orthop,2017,41(5):925-930.
[5]赵旭红,伍骥,李松林,等.全膝关节置换同时进行滑膜切除术与否对初期骨关节炎患者术后炎性周期及临床结果的影响[J].中国矫形外科杂志,2013,21(3):238-242.
[6]Kilicarslan K,Yalcin N,Cicek H,et al.The effect of total synovectomy in total knee arthroplasty:a prospective randomized controlled study[J].Knee Surg Sports Traumatol Arthrosc,2011,19(6):932-935.
[7]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中国矫形外科杂志,2014,22(3):287-288.
[8]任海亮,马信龙,马剑雄.关节置换术后患者血浆乙酰肝素酶的变化的研究[J].中国中西医结合外科杂志,2015,21(3):238-242.
[9]胡洪波,李玉民,李政,等.滑膜切除对全膝关节置换术治疗骨性关节炎临床效果的影响[J].中国骨与关节损伤杂志,2017,32(4):365-367.
[10]黄吉利,罗明,潘捷,等.应用VAS和KSS分析关节镜滑膜切除术后疼痛及膝关节功能[J].基因组学与应用生物学,2017,36(4):1435-1439.
[11]李钦宗,魏万利,郑昆仑,等.关节清理术对膝骨关节炎患者白细胞介素-18、基质金属蛋白酶-13表达的影响[J].中西医结合外科杂志,2017,23(4):415-418.
[12]王华军,李锋,聂喜增,等.全膝关节置换术中滑膜切除对术后功能恢复及失血影响的临床研究[J].中国矫形外科杂志,2015,23(7):610-614.
[13]李治国,杨晓茂,杨洪军,等.切除滑膜对骨性关节炎全膝关节置换患者术后近期疗效及康复效果的影响[J].检验医学与临床,2014,11(5):636-637.
[14]李建锋,崔学文.初次全膝关节置换切除滑膜与失血量及关节功能的相关性[J].中国组织工程研究,2018,22(11):1659-1664..
[15]赵传喜,卢岩岩,陈能,等.滑膜切除对初次全膝关节置换术治疗膝骨关节炎临床疗效的Meta分析[J].风湿病与关节炎,2017,6(6):30-34.
[16]王建明,徐闯,李健,等.初次人工全膝关节置换术中切除滑膜与否对失血量和临床疗效影响的Meta分析[J].中国矫形外科杂志,2018,26(11):1010-1016.
[17]董乃健,柯铭锋,黄柳平.全膝关节置换术中滑膜切除对患者失血量及膝关节功能的影响[J].医学理论与实践,2016,29(21):2939-2941.
[18]宁新创,刘侃,范利中,等.同期和分期的双侧全膝关节置换术151例分析[J].中国中西医结合外科杂志,2017,23(5):478-482.
[19]宁纪斌,田少奇,杨旭,等.滑膜切除对全膝关节置换治疗骨性关节炎的影响[J].齐鲁医学杂志,2014,12(6):519-521.
[20]高玉镭,张寅权,宋方龙,等.切除与不切除滑膜对人工全膝关节置换术后感染影响的比较[J].中国矫形外科杂志,2016,24(5):411-415.
[2]Jones G.Osteoarthritis:where are we for pain and therapy in2013[J].Aust Fam Physician,2013,11(6):766-769.
[3]Seviciu A,Gross I,Fathima S,et al.Effects of tranexamic acid and bipolar sealer alone or in combination in primary total knee arthroplasty:a prospective,randomized,controlled trial[J].Arthroplasty Today,2016,2(2):77-82.
[4]Georgiannos D,Boutsiadis A,Agathangelidis F,et al.Arthroscopically-assisted mini open partial synovectomy for the treatment of localized pigmented villonodular synovitis of the knee.A retrospective comparative study with long-term follow up[J].Int Orthop,2017,41(5):925-930.
[5]赵旭红,伍骥,李松林,等.全膝关节置换同时进行滑膜切除术与否对初期骨关节炎患者术后炎性周期及临床结果的影响[J].中国矫形外科杂志,2013,21(3):238-242.
[6]Kilicarslan K,Yalcin N,Cicek H,et al.The effect of total synovectomy in total knee arthroplasty:a prospective randomized controlled study[J].Knee Surg Sports Traumatol Arthrosc,2011,19(6):932-935.
[7]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中国矫形外科杂志,2014,22(3):287-288.
[8]任海亮,马信龙,马剑雄.关节置换术后患者血浆乙酰肝素酶的变化的研究[J].中国中西医结合外科杂志,2015,21(3):238-242.
[9]胡洪波,李玉民,李政,等.滑膜切除对全膝关节置换术治疗骨性关节炎临床效果的影响[J].中国骨与关节损伤杂志,2017,32(4):365-367.
[10]黄吉利,罗明,潘捷,等.应用VAS和KSS分析关节镜滑膜切除术后疼痛及膝关节功能[J].基因组学与应用生物学,2017,36(4):1435-1439.
[11]李钦宗,魏万利,郑昆仑,等.关节清理术对膝骨关节炎患者白细胞介素-18、基质金属蛋白酶-13表达的影响[J].中西医结合外科杂志,2017,23(4):415-418.
[12]王华军,李锋,聂喜增,等.全膝关节置换术中滑膜切除对术后功能恢复及失血影响的临床研究[J].中国矫形外科杂志,2015,23(7):610-614.
[13]李治国,杨晓茂,杨洪军,等.切除滑膜对骨性关节炎全膝关节置换患者术后近期疗效及康复效果的影响[J].检验医学与临床,2014,11(5):636-637.
[14]李建锋,崔学文.初次全膝关节置换切除滑膜与失血量及关节功能的相关性[J].中国组织工程研究,2018,22(11):1659-1664..
[15]赵传喜,卢岩岩,陈能,等.滑膜切除对初次全膝关节置换术治疗膝骨关节炎临床疗效的Meta分析[J].风湿病与关节炎,2017,6(6):30-34.
[16]王建明,徐闯,李健,等.初次人工全膝关节置换术中切除滑膜与否对失血量和临床疗效影响的Meta分析[J].中国矫形外科杂志,2018,26(11):1010-1016.
[17]董乃健,柯铭锋,黄柳平.全膝关节置换术中滑膜切除对患者失血量及膝关节功能的影响[J].医学理论与实践,2016,29(21):2939-2941.
[18]宁新创,刘侃,范利中,等.同期和分期的双侧全膝关节置换术151例分析[J].中国中西医结合外科杂志,2017,23(5):478-482.
[19]宁纪斌,田少奇,杨旭,等.滑膜切除对全膝关节置换治疗骨性关节炎的影响[J].齐鲁医学杂志,2014,12(6):519-521.
[20]高玉镭,张寅权,宋方龙,等.切除与不切除滑膜对人工全膝关节置换术后感染影响的比较[J].中国矫形外科杂志,2016,24(5):411-415.