肥胖患者全膝关节置换术切口脂肪处理的疗效观察
摘要
目的探讨全膝关节置换术中两种切口脂肪处理方法的临床疗效。方法采用前瞻性随机对照研究方法,将我院2015年1月至2017年1月间收治的行全膝关节置换术的肥胖患者[身体质量指数(body mass index,BMI)大于28kg/m2]随机分为两组。A组105例,其中男45例,女60例;年龄(69.1±5.7)岁,BMI为(28.5±1.2)kg/m2;采用骨刀刮除的钝性处理方式。B组105例,其中男46例,女59例;年龄(68.7±6.1)岁,BMI为(28.3±1.3)kg/m2;采用手术刀切除、组织剪剪除的锐性处理方式。对比两组临床疗效和切口并发症发生率。结果 210例患者均获得12～24个月随访。A组患者无切口并发症发生,B组4例(3.81%)出现切口并发症,差异有统计学意义(P<0.01)。两组术后1d膝关节疼痛视觉模拟评分(visual analogue scale,VAS)、末次随访美国特种外科医院(the hospital special surgery,HSS)膝关节评分比较,差异无统计学意义(P>0.05)。结论肥胖患者行全膝关节置换术时,钝性处理方式可有效保留纤维间隔和毛细血管网,保护存留脂肪组织血供,为皮肤愈合提供血液营养支持,可降低切口并发症;而锐性处理方式,纤维间隔和血管网被一同去除,易损伤健存的脂肪组织,影响切口边缘皮肤血供,出现切口并发症。但在术后膝关节疼痛和关节功能改善方面,两种处理方法差异没有统计学意义。
引文
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[3]Odum SM,Springer BD.Dennos AC,et al.National obesity trends in total knee arthroplasty[J].J Arthroplasty,2013,28(8Suppl):148.
[4]Malinzak RA,Ritter MA,Berend ME,et al.Morbidly obese,diabetic,younger,and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates[J].J Arthroplasty,2009,24(6Suppl):84.
[5]Namba RS,Paxton L,Fithian DC,et al.Obesity and perioperative morbidity in total hip and total knee arthroplasty patients[J].J Arthroplasty,2005,20(7Suppl 3):46.
[6]高辉,吕厚山,等.肥胖病人全膝关节表面置换术后疗效观察[J].中国矫形外科杂志,2005,13(18):1369-1372.
[7]Mark DK,Adam AS,Navin DF,et al.Classifications in brief:kellgren-lawrence classification of osteoarthritis[J].Clin Orthop Relat Res,2016,474(8):1886-1893.
[8]中国肥胖问题工作组.中国成人超重和肥胖预防与控制指南(节录)[J].营养学报,2004,26(1):1-4.
[9]Madeira JB,Carvaiho CN,Gazolla FM,et al.Impact of obesity on metabolic syndrome component and adipokines in prepubertal children[J].J Pediatr(Rio J),2009,85(3):261-268.
[10]吴秀琴,周晓东,葛林伟,等.福建省三城市居民体脂指数、体脂百分比和腰臀比特点的分析[J].中国体育科技,2007,43(5):90-93.
[11]Mendis S,Davis S,Norrving B,et al.Organizational update:the world health organization global status report on noncommunicable diseases 2014;one more landmark step in the combat against stroke and vascular disease[J].Stroke,2015,46(5):121-122.
[12]Fehring TK,Odum SM,Griffin WL,et al.The obesity epidemic:its effect on total joint arthroplasty[J].JArthroplasty,2007,22(6Suppl 2):71-76.
[13]Kozlow JH,Lisiecki J,Terjimanian MN,et al.Cross-sectional area of the abdomen predicts complication incidence in patients undergoing sternal reconstruction[J].J Surg Res,2014,192(2):670.
[14]Mehta AI,Babu R,Karikari IO,et al.2012Young Investigator Award winner:the distribution of body mass as a signi cant risk factor for lumbar spinal fusion postoperative infections[J].Spine(Phila Pa1976),2012,37(19):1652.
[15]Mehta AI,Babu R,Sharma R,et al.Thickness of subcutaneous fat as a risk factor for infection in cervical spine fusion surgery[J].J Bone Joint Surg Am,2016,1(8):1788-1791.
[16]Fujii T,Tsutsumi S,Matsumoto A,et al.Thickness of subcutaneous fat as a strong risk factor for wound infections in elective colorectal surgery:impact of pre-diction using preoperative CT[J].Dig Surg,2010,27(4):331.
[17]Sugisawa N,Tokunaga M,Tanizawa Y,et al.Intraabdominal infectious complications following gastrectomy in patients with excessive visceral fat[J].Gastric Cancer,2012,15(2):206.
[18]吴晓梅,赵新华.腹部切口脂肪液化的原因分析和防治体会[J].重庆医学,2011,40(19):1942-1944.
[19]周宗科,翁习生.中国髋膝关节置换术加速康复-围手术期管理策略专家共识[J].中华骨与关节外科杂志,2016,9(1):1-9.
[20]Maradit KH,Lewallen LW,Mahry TM,et al.Diabetes mellitus,hyperglycemia,hemoglobin A1C and the risk of prosthetic joint infections in total hip and knee arthroplasty[J].J Arthroplasty,2015,30(3):439-443.
[21]Gallagher D,Visser M,Sepulveda D,et al.How useful is body mass index for comparison of body fatness across age,sex,and ethnic groups?[J].Am JEpidemiol,1996,143(3):228.
[22]Watts CD,Houdek MT,Wagner ER,et al.Subcutaneous fat thickness is associated with early reoperation and infection after total knee arthroplasty in morbidly obese patients[J].J Arthroplasty,2016,31(8),1788-1791.