人工关节置换术后隐性失血影响因素研究进展
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摘要
人工关节置换术是关节疾病保守治疗无效时的重要治疗手段。人工关节置换术中失血及术后血红蛋白显著下降给患者术后的功能锻炼及康复带来了不良影响,如手术切口愈合延迟、感染率增加、康复时间延长、出院所需时间增加等严重影响患者的满意度。近些年发现,手术创伤造成的出血进入组织间隙及关节腔和溶血等所引起的隐性失血是术后血红蛋白显著下降的主要原因,而性别、年龄、体质指数、基础疾病、止血带、手术入路、抗凝药等与隐形失血量有关。
Artificial joint arthroplasty is an important treatment method when conservative treatment is invalid. Intraoperative blood loss during artificial joint arthroplasty and postoperative hemoglobin reduction have negative effect on postoperative functional exercise and rehabilitation,such as surgical incision healing delay,increased infection rate,extended hospitalization time,which seriously impact the patient satisfaction. In recent years,a large number of studies suggest that hidden blood loss caused by surgical trauma hemorrhage entering the tissue space and articular cavity,and hemolysis are the main reasons for significant postoperative hemoglobin decrease. In addition,the age,gender,body mass index,basic disease,tourniquet,surgical approach,anticoagulant and so on are related to hidden blood loss.
Artificial joint arthroplasty is an important treatment method when conservative treatment is invalid. Intraoperative blood loss during artificial joint arthroplasty and postoperative hemoglobin reduction have negative effect on postoperative functional exercise and rehabilitation,such as surgical incision healing delay,increased infection rate,extended hospitalization time,which seriously impact the patient satisfaction. In recent years,a large number of studies suggest that hidden blood loss caused by surgical trauma hemorrhage entering the tissue space and articular cavity,and hemolysis are the main reasons for significant postoperative hemoglobin decrease. In addition,the age,gender,body mass index,basic disease,tourniquet,surgical approach,anticoagulant and so on are related to hidden blood loss.
引文
[1]Pattison E,Protheroe K,Pringle RM,et al.Reduction in haemoglobin after knee joint surgery[J].Ann Rheum Dis,1973,32(6):582-584.
[2]Sehat KR,Evans R,Newman JH.How much blood is really lost in total knee arthroplasty correct blood loss management should take hidden loss into account[J].Knee,2000,7(3):151-155.
[3]Erskine JG,Fraser C,Simpson R,et al.Blood loss with knee joint replacement[J].J R Coll Surg Edinb,1981,26(5):295-297.
[4]Mc Manus KT,Velchik MG,Alavi A,et al.Non-invasive assessment of postoperative bleeding in TKA patients with99Tcm,RNCs[J].J Nucl Med,1987,28:565-567.
[5]Faris PM,Ritter MA,Keating EM,et al.Unwashed filtered shed blood collected after knee and hip arthroplasties.A source of autologous red blood cells[J].J Bone Joint Surg Am,1991,73(8):1169-1178.
[6]袁涛,丛宇,赵建宁,等.亚油酸与红细胞急性损伤:人工关节置换后隐性失血的发病机制[J].中国组织工程研究,2014,18(48):7739-7744.
[7]Prasad N,Padmanabhan V,Mullaji A.Blood loss in total knee arthroplasty:An analysis of risk factors[J].Int Orthop,2007,31(1):39-44.
[8]高玉镭,李佩佳,田敏,等.人工全膝关节置换术隐性失血的发生机制及影响因素分析[J].中国矫形外科杂志,2012,20(3):209-212.
[9]夏克明,朱伟民,杨鹏,等.老年人工全髋关节置换术与全膝关节置换术后隐性失血的相关机制及输血策略[J].中国老年学杂志,2017,37(8):1954-1956.
[10]杨晓萍,李佩佳,田敏.老年全膝关节置换术隐性失血量的评估与处理[J].中国矫形外科杂志,2016,24(12):1145-1147.
[11]楼才俊,蔡明,章银灿,等.高龄股骨粗隆间骨折患者PFNA和人工股骨头置换围手术期隐性失血对比分析[J].浙江创伤外科,2016,21(3):431-432.
[12]黄家谷,张克,田华,等.单侧初次全膝关节置换后隐性失血的因素分析[J].中国组织工程研究,2016,20(26):3823-3829.
[13]Hrnack SA,Skeen N,Xu T,et al.Correlation of body mass index and blood loss during total knee and total hip arthroplasty[J].Am J Orthop(Belle Mead NJ),2012,41(10):467-471.
[14]刘志刚,张上上,陈如见,等.全髋关节置换后的隐性失血[J].中国组织工程研究,2013,17(13):2305-2314.
[15]Zhao JZ,Li J,Zheng W,et al.Low body mass index and blood loss in primary totalhip arthroplasty:Results from 236 consecutive ankylosing spondylitis patients[J].Biomed Res Int,2014,2014(10):1155-1161.
[16]石士平,李伟,张伟,等.膝骨性关节炎分级与全膝关节置换后隐性失血[J].中国组织工程研究,2013,17(35):6234-6239.
[17]Domingues VR,de Campos GC,Plapler PG,et al.Prevalence of osteoporosis in patients awaiting total hip arthroplasty[J]Acta Ortop Bras,2015,23(1):34-37.
[18]于泽,董乐乐,连建强,等.全膝人工关节置换术后隐性失血的研究进展[J].中国医药指南,2013,11(16):101-103.
[19]马续彬,曲彦隆.减少全膝关节置换隐性失血的措施研究进展[J].医学综述,2017,23(2):298-301.
[20]曹学伟,徐逸生,招伟贤,等.出血控制策略在股内侧肌入路全膝置换中的运用[J].广东医学,2011,32(22):2903-2905.
[21]Jung YB,Lee YS,Lee EY,et al.Comparison of the modified subvastus and medial parapatellar approaches in total knee arthroplasty[J].Int Orthop,2009,33(2):419-423.
[22]Bannister GC,Miles AW.The influence of cementing technique and blood on the strength of the bone-cement interface[J].Eng Med,1988,17(3):131-133.
[23]Lee AJ,Ling RS,Vangala SS.Some clinically relevant variables affecting the mechanical behaviour of bone cement[J].Arch Orthop Trauma Surg,1978,92(1):1-18.
[24]Kvederas G,Porvaneckas N,Andrijauskas A,et al.A randomized double-blind clinical trial of tourniquet application strategies for total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2013,21(12):2790-2799.
[25]Steffin B,Green-Riviere E,Giori NJ.Timing of tourniquet release in total knee arthroplasty when using a postoperative blood salvage drain[J].J Arthroplasty,2009,24(4):539-542.
[26]Li B,Wen Y,Wu H,et al.The effect of tourniquet use on hidden blood loss in total knee arthroplasty[J].Int Orthop,2009,33(5):1263-1268.
[27]闫昌葆,陈百成,赵宝辉,等.全膝关节表面置换术中止血带不同使用方法的早期临床效果比较[J].中国矫形外科杂志,2009,17(8):597-599.
[28]Yavarikia A,Amjad GG,Davoudpour K.The influence of tourniquet use and timing of its release on blood loss in total knee arthroplasty[J].Pak J Biol Sci,2010,13(5):249-252.
[29]陆军,宋东辉,曾宪帆,等.全膝关节置换术中是否使用止血带Meta分析[J].中国中西医结合外科杂志,2014,20(6):581-586.
[30]曹力,尼加提·阿不力米提,阿斯哈尔江·买买提明,等.单侧全膝人工关节置换术后引流选择的随机对照研究[J].中华外科杂志,2009,47(18):1390-1393.
[31]卢道云,黄强,栗景峰,等.局部应用氨甲环酸不放置引流对降低全膝置换隐性失血的疗效[J].临床骨科杂志,2016,19(3):324-327.
[32]Shen PC,Jou IM,Lin YT,et al.Comparison between 4-hour clamping drainage and nonclamping drainage after total knee arthroplasty[J].J Arthroplasty,2005,20(7):909-913.
[33]高文香,郝军,叶晔,等.双膝关节同时表面置换术后隐性失血及其与引流管的关系[J].中国骨与关节损伤杂志,2008,23(7):575-576.
[34]宋子卫,林舟丹,何少康.全髋关节置换术后引流管夹闭与隐性失血量的关系[J].临床骨科杂志,2017,20(2):182-184.
[35]Liu XH,Fu PL,Wang SY,et al.The effect of drainage tube on bleeding and prognosis after total knee arthroplasty:A prospective cohort study[J].J Orthop Surg Res,2014,9:27.
[36]Liu J,Li YM,Cao JG,et al.Effects of knee position on blood loss following total knee arthroplasty:A randomized,controlled study[J].J Orthop Surg Res,2015,10:69.
[37]Yang Y,Yong-Ming L,Pei-Jian D,et al.Leg position influences early blood loss and functional recovery following total knee arthroplasty:A randomized study[J].Int J Surg,2015,23(Pt A):82-86.
[38]Li B,Wang G,Wang Y,et al.Effect of two limb positions on venous hemodynamics and hidden blood loss following total knee arthroplasty[J].J Knee Surg,2017,30(1):70-74.
[39]Li B,Wen Y,Liu D,et al.The effect of knee position on blood loss and range of motion following total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2012,20(3):594-599.
[40]张国妹,姚剑英,周玉娟,等.生物冰袋冷敷在全膝关节置换术护理中的应用[J].广东医学,2011,32(19):2616-2617.
[41]陈德胜,金群华,李亚平,等.隐性失血对双侧人工全膝关节同期置换手术的影响[J].中国矫形外科杂志,2007,15(17):1290-1292.
[42]Roy SP,Tanki UF,Dutta A,et al.Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2012,20(12):2494-2051.
[43]郭峰.氨甲环酸对单侧全髋关节置换术隐性失血的影响分析[J].中国实用医药,2017,12(1):107-109.
[44]Huang GP,Jia XF,Xiang Z,et al.Tranexamic acid reduces hidden blood loss in patients undergoing total knee arthroplasty:A comparative study and Meta-analysis[J].Med Sci Monit,2016,22:797-802.
[45]Shen FP,Hou WL,Chen JB,et al.Effectiveness and safety of tranexamic acid for total knee arthroplasty:A prospective randomized controlled trial[J].Med Sci Monit,2015,21:576-581.
[46]张家恺,梁培雄,刘忠.局部使用氨甲环酸联合肾上腺素对全髋关节置换术后失血量的影响[J].临床骨科杂志,2017,20(1):58-61.
[47]Gao F,Sun W,Guo W,et al.Topical application of tranexamic acid plus diluted epinephrine reduces postoperative hidden blood loss in total hip arthroplasty[J].J Arthroplasty,2015,30(12):2196-2200.
[48]时利军,白禹,高福强,等.鸡尾酒疗法减少全髋关节置换后的隐性失血[J].中国组织工程研究,2016,20(48):7156-7162.
[49]高乐才,吴文元,魏金栋,等.利伐沙班与低分子肝素对髋、膝关节置换术后隐性失血影响的对比观察[J].现代中西医结合杂志,2013,22(7):721-722.
[50]王大城,郭汉明,黄杰华,等.利伐沙班与依诺肝素钠对髋膝关节置换术后下肢深静脉血栓形成及围手术期隐性失血的影响[J].海南医学,2017,28(5):752-754.
[51]李军,荆珏华,史占军,等.利伐沙班对全髋关节置换术隐性出血影响的病例对照研究[J].中国骨伤,2014,27(1):34-37.
[2]Sehat KR,Evans R,Newman JH.How much blood is really lost in total knee arthroplasty correct blood loss management should take hidden loss into account[J].Knee,2000,7(3):151-155.
[3]Erskine JG,Fraser C,Simpson R,et al.Blood loss with knee joint replacement[J].J R Coll Surg Edinb,1981,26(5):295-297.
[4]Mc Manus KT,Velchik MG,Alavi A,et al.Non-invasive assessment of postoperative bleeding in TKA patients with99Tcm,RNCs[J].J Nucl Med,1987,28:565-567.
[5]Faris PM,Ritter MA,Keating EM,et al.Unwashed filtered shed blood collected after knee and hip arthroplasties.A source of autologous red blood cells[J].J Bone Joint Surg Am,1991,73(8):1169-1178.
[6]袁涛,丛宇,赵建宁,等.亚油酸与红细胞急性损伤:人工关节置换后隐性失血的发病机制[J].中国组织工程研究,2014,18(48):7739-7744.
[7]Prasad N,Padmanabhan V,Mullaji A.Blood loss in total knee arthroplasty:An analysis of risk factors[J].Int Orthop,2007,31(1):39-44.
[8]高玉镭,李佩佳,田敏,等.人工全膝关节置换术隐性失血的发生机制及影响因素分析[J].中国矫形外科杂志,2012,20(3):209-212.
[9]夏克明,朱伟民,杨鹏,等.老年人工全髋关节置换术与全膝关节置换术后隐性失血的相关机制及输血策略[J].中国老年学杂志,2017,37(8):1954-1956.
[10]杨晓萍,李佩佳,田敏.老年全膝关节置换术隐性失血量的评估与处理[J].中国矫形外科杂志,2016,24(12):1145-1147.
[11]楼才俊,蔡明,章银灿,等.高龄股骨粗隆间骨折患者PFNA和人工股骨头置换围手术期隐性失血对比分析[J].浙江创伤外科,2016,21(3):431-432.
[12]黄家谷,张克,田华,等.单侧初次全膝关节置换后隐性失血的因素分析[J].中国组织工程研究,2016,20(26):3823-3829.
[13]Hrnack SA,Skeen N,Xu T,et al.Correlation of body mass index and blood loss during total knee and total hip arthroplasty[J].Am J Orthop(Belle Mead NJ),2012,41(10):467-471.
[14]刘志刚,张上上,陈如见,等.全髋关节置换后的隐性失血[J].中国组织工程研究,2013,17(13):2305-2314.
[15]Zhao JZ,Li J,Zheng W,et al.Low body mass index and blood loss in primary totalhip arthroplasty:Results from 236 consecutive ankylosing spondylitis patients[J].Biomed Res Int,2014,2014(10):1155-1161.
[16]石士平,李伟,张伟,等.膝骨性关节炎分级与全膝关节置换后隐性失血[J].中国组织工程研究,2013,17(35):6234-6239.
[17]Domingues VR,de Campos GC,Plapler PG,et al.Prevalence of osteoporosis in patients awaiting total hip arthroplasty[J]Acta Ortop Bras,2015,23(1):34-37.
[18]于泽,董乐乐,连建强,等.全膝人工关节置换术后隐性失血的研究进展[J].中国医药指南,2013,11(16):101-103.
[19]马续彬,曲彦隆.减少全膝关节置换隐性失血的措施研究进展[J].医学综述,2017,23(2):298-301.
[20]曹学伟,徐逸生,招伟贤,等.出血控制策略在股内侧肌入路全膝置换中的运用[J].广东医学,2011,32(22):2903-2905.
[21]Jung YB,Lee YS,Lee EY,et al.Comparison of the modified subvastus and medial parapatellar approaches in total knee arthroplasty[J].Int Orthop,2009,33(2):419-423.
[22]Bannister GC,Miles AW.The influence of cementing technique and blood on the strength of the bone-cement interface[J].Eng Med,1988,17(3):131-133.
[23]Lee AJ,Ling RS,Vangala SS.Some clinically relevant variables affecting the mechanical behaviour of bone cement[J].Arch Orthop Trauma Surg,1978,92(1):1-18.
[24]Kvederas G,Porvaneckas N,Andrijauskas A,et al.A randomized double-blind clinical trial of tourniquet application strategies for total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2013,21(12):2790-2799.
[25]Steffin B,Green-Riviere E,Giori NJ.Timing of tourniquet release in total knee arthroplasty when using a postoperative blood salvage drain[J].J Arthroplasty,2009,24(4):539-542.
[26]Li B,Wen Y,Wu H,et al.The effect of tourniquet use on hidden blood loss in total knee arthroplasty[J].Int Orthop,2009,33(5):1263-1268.
[27]闫昌葆,陈百成,赵宝辉,等.全膝关节表面置换术中止血带不同使用方法的早期临床效果比较[J].中国矫形外科杂志,2009,17(8):597-599.
[28]Yavarikia A,Amjad GG,Davoudpour K.The influence of tourniquet use and timing of its release on blood loss in total knee arthroplasty[J].Pak J Biol Sci,2010,13(5):249-252.
[29]陆军,宋东辉,曾宪帆,等.全膝关节置换术中是否使用止血带Meta分析[J].中国中西医结合外科杂志,2014,20(6):581-586.
[30]曹力,尼加提·阿不力米提,阿斯哈尔江·买买提明,等.单侧全膝人工关节置换术后引流选择的随机对照研究[J].中华外科杂志,2009,47(18):1390-1393.
[31]卢道云,黄强,栗景峰,等.局部应用氨甲环酸不放置引流对降低全膝置换隐性失血的疗效[J].临床骨科杂志,2016,19(3):324-327.
[32]Shen PC,Jou IM,Lin YT,et al.Comparison between 4-hour clamping drainage and nonclamping drainage after total knee arthroplasty[J].J Arthroplasty,2005,20(7):909-913.
[33]高文香,郝军,叶晔,等.双膝关节同时表面置换术后隐性失血及其与引流管的关系[J].中国骨与关节损伤杂志,2008,23(7):575-576.
[34]宋子卫,林舟丹,何少康.全髋关节置换术后引流管夹闭与隐性失血量的关系[J].临床骨科杂志,2017,20(2):182-184.
[35]Liu XH,Fu PL,Wang SY,et al.The effect of drainage tube on bleeding and prognosis after total knee arthroplasty:A prospective cohort study[J].J Orthop Surg Res,2014,9:27.
[36]Liu J,Li YM,Cao JG,et al.Effects of knee position on blood loss following total knee arthroplasty:A randomized,controlled study[J].J Orthop Surg Res,2015,10:69.
[37]Yang Y,Yong-Ming L,Pei-Jian D,et al.Leg position influences early blood loss and functional recovery following total knee arthroplasty:A randomized study[J].Int J Surg,2015,23(Pt A):82-86.
[38]Li B,Wang G,Wang Y,et al.Effect of two limb positions on venous hemodynamics and hidden blood loss following total knee arthroplasty[J].J Knee Surg,2017,30(1):70-74.
[39]Li B,Wen Y,Liu D,et al.The effect of knee position on blood loss and range of motion following total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2012,20(3):594-599.
[40]张国妹,姚剑英,周玉娟,等.生物冰袋冷敷在全膝关节置换术护理中的应用[J].广东医学,2011,32(19):2616-2617.
[41]陈德胜,金群华,李亚平,等.隐性失血对双侧人工全膝关节同期置换手术的影响[J].中国矫形外科杂志,2007,15(17):1290-1292.
[42]Roy SP,Tanki UF,Dutta A,et al.Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2012,20(12):2494-2051.
[43]郭峰.氨甲环酸对单侧全髋关节置换术隐性失血的影响分析[J].中国实用医药,2017,12(1):107-109.
[44]Huang GP,Jia XF,Xiang Z,et al.Tranexamic acid reduces hidden blood loss in patients undergoing total knee arthroplasty:A comparative study and Meta-analysis[J].Med Sci Monit,2016,22:797-802.
[45]Shen FP,Hou WL,Chen JB,et al.Effectiveness and safety of tranexamic acid for total knee arthroplasty:A prospective randomized controlled trial[J].Med Sci Monit,2015,21:576-581.
[46]张家恺,梁培雄,刘忠.局部使用氨甲环酸联合肾上腺素对全髋关节置换术后失血量的影响[J].临床骨科杂志,2017,20(1):58-61.
[47]Gao F,Sun W,Guo W,et al.Topical application of tranexamic acid plus diluted epinephrine reduces postoperative hidden blood loss in total hip arthroplasty[J].J Arthroplasty,2015,30(12):2196-2200.
[48]时利军,白禹,高福强,等.鸡尾酒疗法减少全髋关节置换后的隐性失血[J].中国组织工程研究,2016,20(48):7156-7162.
[49]高乐才,吴文元,魏金栋,等.利伐沙班与低分子肝素对髋、膝关节置换术后隐性失血影响的对比观察[J].现代中西医结合杂志,2013,22(7):721-722.
[50]王大城,郭汉明,黄杰华,等.利伐沙班与依诺肝素钠对髋膝关节置换术后下肢深静脉血栓形成及围手术期隐性失血的影响[J].海南医学,2017,28(5):752-754.
[51]李军,荆珏华,史占军,等.利伐沙班对全髋关节置换术隐性出血影响的病例对照研究[J].中国骨伤,2014,27(1):34-37.