| 孙相祥,马建兵,肖琳,等.人工全膝关节置换术中保留滑膜对术后感染的预防效果[J].安徽医药,2018,22(5):848-852. |
| 人工全膝关节置换术中保留滑膜对术后感染的预防效果 |
| Prevention of postoperative infection with retained synovial membrane in total knee arthroplasty |
| 投稿时间：2017-02-23 |
| DOI： |
| 中文关键词: 人工全膝关节置换术 滑膜 膝关节功能 感染 预防效果 |
| 英文关键词: total knee arthroplasty synovium knee joint function infection prevention effect |
| 基金项目: |
| 作者 | 单位 | | 孙相祥 | 西安市红会医院骨科,陕西 西安 710054, | | 马建兵 | 西安市红会医院骨科,陕西 西安 710054, | | 肖琳 | 西安市红会医院骨科,陕西 西安 710054, | | 姚舒馨 | 西安市红会医院骨科,陕西 西安 710054, | | 贺强 | 西安交通大学第二附属医院骨科,陕西 西安 710004 | | 赵波 | 西安交通大学第二附属医院骨科,陕西 西安 710004 |
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| 中文摘要: |
| 目的 探析人工全膝关节置换术(TKA)中保留滑膜对术后感染的预防效果,进一步明确其可行性和临床效果。方法 回顾性分析2014年1月—2016年1月248例行单膝TKA原发性膝骨关节炎患者的临床资料,均行TKA治疗,对照组120例术中切除滑膜,观察组128例术中保留滑膜,对比两组患者一般手术情况、感染指标水平变化情况、膝关节功能恢复及感染情况。结果 对照组患者手术时间(89.56±26.35) min、术中出血量(472.42±86.18) mL、术后24 h引流量(685.25±92.68) mL及术后输血率29.17%均明显高于观察组[(71.25±21.58) min、(198.56±48.52) mL、(354.26±75.28) mL、10.94%](均P＜0.05),两组患者在术后1周关节活动范围、住院时间基本相近(均P＞0.05)；两组患者各项指标术后1 d、术后7 d均较术前明显增高,于术后14 d降至正常水平。观察组患者WBC、CRP、血沉水平在术前、术后1、7、14 d、术后6、12周、术后6月、术后1年8个不同时间段均稍高于对照组,但经组间t检验均P＞0.05；观察组术后12周HSS评分表中功能评分(19.65±2.46) 分和总评分(86.06±1.68) 分均高于对照组[(18.92±2.36)、(85.06±1.58) 分](均P＜0.05),其他项评分两组评分基本相近(均P＞0.05)；术后1年HSS评分表中各项评分和总评分基本相近(均P＞0.05)；观察组患者术后感染率为0.78%明显低于对照组的5.00%(P＜0.05)。结论 人工全膝关节置换术中保留滑膜可缩短手术时间、减少出血量和输血量进而预防术后感染的发生,且不影响患者术后膝关节功能恢复,可在TKA手术中广泛开展。 |
| 英文摘要: |
| Objective To explore the preventive effect of retained synovial membrane on postoperative infection in total knee arthroplasty (TKA),and further clarify its feasibility and clinical effect. Methods A retrospective analysis was made of clinical data of 248 cases of single knee TKA primary knee osteoarthritis patients,who were treated with TKA from January 2014 to January 2016,0 cases in the control group with synovectomy,and 128 patients in the observation group with preservation of synovial membrane.Comparison was conducted of general surgery,infection index changes,recovery of knee joint function and infection between the two groups. Results The operation time [(89.56 ± 26.35) min],intraoperative blood loss [(472.42±86.18) mL],postoperative 24 h drainage volume [(685.25±92.68) mL] and postoperative blood transfusion rate (29.17%) in the control group were significantly higher than those in the observation group [(71.25±21.58) min,(198.56±48.52) mL,(354.26±75.28) mL, 10.94%] (all P<0.05);One week after surgery,the two groups of had similar scope of joint activity and hospitalization time (all P>0.05).Each index of the two groups of patients 1 d,7 d after operation was significantly higher than that preoperatively,and decreased to normal level on the 14th day after surgery.The observation group of patients′ WBC,CRP,ESR levels at 8 different time points,including preoperatively,1,7,14 d,6-week,12-week,6-month and 1-year postoperatively,were slightly higher compared with the control group,but the t test between groups showed that P>0.05.The functional score [(19.65±2.46) points] and total score [(86.06±1.68) points] in the 12-week HSS scoring table were higher than those in the control group [(18.92±2.36) points,(85.06±1.58) points] (all P<0.05), while other scores of the two groups were similar (P>0.05).The scores and total score of the 1 year postoperative HSS score were approximately similar (all P>0.05).The postoperative infection rate of the observation group (0.78%) was significantly higher than 5.00% of the control group (P<0.05). Conclusions Synovial retention in total knee arthroplasty can shorten the operation time,prevent postoperative blood loss and transfusion to reduce the incidence of infection,and doesnot affect the postoperative recovery of knee joint function after surgery,which can be widely carried out in TKA. |
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