不同年龄患者人工膝关节置换术后疗效与围手术期并发症分析

不同年龄患者人工膝关节置换术后疗效与围手术期并发症分析 不同年龄患者人工膝关节置换术后 疗效与围手术期并发症分析 周一新邵宏翊唐竟唐杞衡 【摘要】 目的探讨不同年龄段患者接受人工膝关节置换术疗效和围手术期并发症。方法对 2004年1月至2005年3月在北京积水潭医院接受人工膝关节置换的212例患者300膝进行回顾性 分析，将患者按不同年龄进行分组。对不同组别进行膝关节评分(KSs评分)并统计系统与局部并发 症。结果不同组别患者通过人工膝关节置换手术KSs评分均获得提高，并且70岁以上进行双侧人 工膝关节置换的患者膝关节功能提高优于其他各组(P

不同年龄患者人工膝关节置换术后 疗效与围手术期并发症分析 周一新邵宏翊唐竟唐杞衡 【摘要】 目的探讨不同年龄段患者接受人工膝关节置换术疗效和围手术期并发症。方法对 2004年1月至2005年3月在北京积水潭医院接受人工膝关节置换的212例患者300膝进行回顾性 分析，将患者按不同年龄进行分组。对不同组别进行膝关节评分(KSs评分)并统计系统与局部并发 症。结果不同组别患者通过人工膝关节置换手术KSs评分均获得提高，并且70岁以上进行双侧人 工膝关节置换的患者膝关节功能提高优于其他各组(P中的格式为准；中文期刊用全名。每条参考文献均须著录起止页。每年连续编码的期刊可以不著 录期号。 示例如下： [1]卢绮萍，裘法祖，吴在德，等．不同肝缺血时限肝硬变及非肝硬变肝组织基因差异表达及其意义．中华外科杂志。 200r7，45：50-53． [2]Halp唧sD，ubelPA，c印lalIALsobd—org细haI嵋plaIlt“伽inHⅣ·in‰自edpalien慷NEIIglJMed，2002，347：284瑚7． [3]Mu咖yPR，RDBenm且ll(s，l(o呐瑚hiGs，eIaLMedicalMic阳牺olo移4tIl乱SLL枷B：M∞by，2∞2：l踟． [4]诸骏仁．昏厥与休克／／董承琅，陶寿淇，陈灏珠．实用心脏病学．3版．上海：上海科学技术出版社，1993：561．5晒． 1J 1J 1；1； n 心 口 H 随 哺 p 竺I 万方数据 不同年龄患者人工膝关节置换术后疗效与围手术期并发症分 析 作者： 周一新， 邵宏翊， 唐竟， 唐杞衡， ZHOU Yi-xin， SHAO Hong-yi， TANG Jing， TANG Qi-heng 作者单位： 北京积水潭医院矫形骨科,100035 刊名： 中华外科杂志 英文刊名： CHINESE JOURNAL OF SURGERY 年，卷(期)： 2009，47(11) 被引用次数： 0次 参考文献(16条) 1.Buechel FF.Buechel FF Jr.Pappas M J Twenty year evaluation of meniscal bearing and rotating platform knee replacement 2001(388) 2.Pavone V.Boettner F.Fickert S Total condylar knee arthroplnsty:A long term followup 2001(388) 3.Sextro GS.Bent DJ.Rand JA Total knee arthroplasty using cruciateretaining kinematic condylar prosthesis 2001(388) 4.Hirsch CH When your patient needs surgery:How planning can avoid complications 1995 5.Tankersley SW.Hungerford DS Total knee arthriplusty in the very aged 1995(316) 6.Cohn BT.Krackow KA.Hungedord DS Results of total knee arthroplusty in patients 80 years and older 1990 7.Zicat B.Rorabeck CH.Bourne RB Total knee mhroplnsty in the octogenarian 1993 8.Lane GJ.Hozack WJ Simultaneous bilateral versus unilateral total knee arthroplasty.Outcome anulysis 1997(345) 9.Cohen RG.Forrest CJ.Benjamin JB Safety and efficacy of bilateral total knee arthroplnsty 1997 10.Anderson JG.Wixson RL.Tsai D Functional outcome and patient satisfaction in total knee patients over the age of 75 1996 11.Brander VA.Mulhotra S.Jet J Outcome of hip and knee arthroplasty in persons aged 80 years and older 1997(345) 12.Birdsull PD.Hayes JH.Clcory R Health outcome after total knee replacement in the very elderly 1999 13.Parvizi J.Mui A.Purtill JJ Total joint arthroplasty:When do fatal or near-fatal complications occar? 2007 14.Hernández-Vaquero D.Femández-Carreira JM.Pérez-Hernández D Total knee arthroplasty in the elderly,Is there an age limit? 2006 15.Detsky AS.Abrams HB.McLaughLin JR Predicting cardiac complication in patients undergoing non- cardiac surgery 1986 16.London MJ.Tuban JF.Wong MG The natural history of segmental wall motion abnormalities in patients undergoing noncardiac surgery 1990 相似文献(10条) 1.外文期刊 Habermann.B.Eberhardt.C.Kurth.AA Total joint replacement in HIV positive patients. BACKGROUND: Recent HIV therapies have improved life expectancy in HIV positive patients. For the purpose of the following retrospective investigation, we analyzed the results of total joint replacement in HIV positive patients. This study exemplifies orthopaedic treatment options and perioperative problems in HIV positive patients. Our population included a high proportion of hemophilic patients. DESIGN AND METHODS: Between 1988 and 2000, we performed 55 endoprosthetic procedures (20 total hip replacements (THR), 33 total knee replacements (TKR), two shoulder replacements) in 41 patients suffering form HIV. Thirty patients are afflicted with hemophilia, seven patients were intravenous drug addicts. The mean follow-up was 81 months (2-14) years. Patients were seen annually; either the Harris Hip Score or the Knee Society Rating System was applied. RESULTS: The following septic complications were observed: a mycotic abscess of both hips 5/10 months after bilateral THR, two early infections following coxitis in patients with intravenous drug abuse, and one further case of septic loosening after 15 months in one patient after THR. Furthermore, one aseptic loosening of a THR after 14 months in a hemophilic patient was seen. After TKR, two early infections in patients with intravenous drug addiction were seen. The total complication rate was 12.7%. A coherency between the infection rate and the CD4+ count was not seen. DISCUSSION: An analysis of the results shows that the complications occurred in patients living under difficult social circumstances. Whereas total joint replacement in hemophilic patients with or without HIV seems to be a fairly safe procedure concerning the postoperative infection rate, intravenous drug abuse increases the risk. Functional outcome does not differ from an HIV negative population both in the TKR and THR groups. 2.外文期刊 Khan.RJ.Fick.D.Yao.F.Tang.K.Hurworth.M.Nivbrant.B.Wood.D A comparison of three methods of wound closure following arthroplasty: a prospective, randomised, controlled trial. We carried out a blinded prospective randomised controlled trial comparing 2-octylcyanoacrylate (OCA), subcuticular suture (monocryl) and skin staples for skin closure following total hip and total knee arthroplasty. We included 102 hip replacements and 85 of the knee.OCA was associated with less wound discharge in the first 24 hours for both the hip and the knee. However, with total knee replacement there was a trend for a more prolonged wound discharge with OCA. With total hip replacement there was no significant difference between the groups for either early or late complications. Closure of the wound with skin staples was significantly faster than with OCA or suture. There was no significant difference in the length of stay in hospital, Hollander wound evaluation score (cosmesis) or patient satisfaction between the groups at six weeks for either hips or knees.We consider that skin staples are the skin closure of choice for both hip and knee replacements. 3.外文期刊 Borghi.B.Casati.A Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen. The Rizzoli Study Group on Orthopaedic Anaesthesia. The efficacy of an integrated autotransfusion regimen, including pre-donation and perioperative salvage of autologous blood, was prospectively evaluated in 2884 patients undergoing total hip (n = 2016) or knee arthroplasty (n = 480), and hip revision (n = 388) with either balanced general, regional, or integrated epidural/general anaesthesia. Allogenic concentrated red blood cells were transfused in the presence of symptomatic anaemia or when haemoglobin concentration was < 6 g dL-1 (10 g dL-1 in patients affected by cerebrovascular or coronary artery disease) after all salvaged and pre-donated autologous blood had been transfused. A total of 278 patients (9.6%) received allogenic blood. Risk factors for allogenic blood transfusion were: preoperative haemoglobin concentration < 10 g dL-1 (after autologous blood pre-donations) (Odds ratio: 8.7; 95% CI: 6.5-16.8; P = 0.004), hip revision versus hip or knee arthroplasty (Odds ratio: 5.8; 95% CI: 3.9-8.5; P = 0. 0001) and inability in obtaining the number of pre- donations required by the Maximum Surgery Blood Order on Schedule (Odds ratio: 3.4; 95% CI: 2.7-4.1; P = 0.0001). The incidence of perioperative complications, including wound infection and haematoma, as well as myocardial ischaemia, respiratory failure and thromboembolic complications, was higher in those patients requiring allogenic blood transfusion (29.8%) than that observed in patients receiving only autologous blood (6.6%) (P = 0.0005); while the mean time duration from surgical procedure to patient discharge from the orthopaedic ward was shorter in those patients not receiving allogenic blood transfusion (12 days; 25-75th percentiles: 8-14 days) than in those patients who required perioperative transfusion with allogenic blood (15 days; 25-75th percentiles: 10-17 days) (P = 0.0005). In conclusion, this prospective study highlighted the clinical relevance of applying an extensive and integrated autotransfusion regimen in order to reduce allogenic blo 4.外文期刊 Moonen.AF.Thomassen.BJ.van-Os.JJ.Verburg.AD.Pilot.P Retransfusion of filtered shed blood in everyday orthopaedic practice. The efficiency of post-operative cell saving after major joint arthroplasty has been demonstrated in prospective studies focusing on blood management. In everyday practice, however, it is likely that transfusion policy is followed less rigorously because of a slackening in attention to blood management, with a reduced efficiency of post-operative cell saving. The primary research question of this retrospective study was whether the number of allogeneic blood transfusions administered to patients treated with a retransfusion system was similar to the results found in a preceding prospective study. A total of 438 patients treated with the Bellovac ABT retransfusion system were analysed in which the majority was operated on a total hip arthroplasty (THA) and total knee arthroplasty (TKA). The amount of retransfused shed blood, the perioperative haemoglobin levels and the number of allogeneic blood transfusions were registered. The average amount of retransfusion was 152 mL in THA and 410 mL in TKA, whereas the allogeneic blood transfusion rate was 8.4 and 5.1% in both groups, respectively. The average percentage of allogeneic blood transfusions administered in this study (i.e. 7%) proved to be marginally higher than the percentage found in a preceding prospective study (i.e. 6%) because of slackening of attention for transfusion policy in everyday practice. Limited bone resection procedures such as resurfacing THA or unicompartmental knee arthroplasty were associated with very limited shed blood and low risk of allogeneic blood transfusion, indicating the doubtful cost efficiency of using a retransfusion system in these patients. It can be concluded that the efficiency of the retransfusion system in everyday practice was similar to the efficiency shown in a preceding prospective study focusing on blood management. However, continual training of the clinical team is crucial. 5.期刊论文 王晓永.张卫国.吕德成.李洪敬 金属对金属全髋关节置换与全膝关节置换术后早期钴铬钼离子的释出 -中华骨科杂志2009,29(10) 目的 研究金属对金属伞髋关节置换与全膝关节置换术后早期患者体内钴、铬、钼离子的释出情况.方法 选择2007年5月至2008年3月实施的金属对会 属全髋关节置换10例,全膝关节置换8例.假体选择采取随机原则.分别于术前和术后第2、6、12、24周采集静脉全血,应用双聚焦电感耦合等离子体质谱法 测量钴、铬、钼离子在血浆样品中的浓度.结果 (1)金属对金属全髋关节置换及全膝关节置换术后患者血浆中钴、铬离子水平增高,于术后2周开始至6周 增高明显,6周时离子浓度达到峰值,6周后离子浓度逐渐下降,12周下降至2周水平,24周离子下降趋势逐渐减慢.(2)金属对金属全髋关节置换术后6、12、 24周钴、铬离子浓度低于全膝关节置换术患者.(3)使用锻造工艺假体患者术后血浆钴、铬离子浓度低于使用铸造工艺假体患者.(4)两组患者随访半年内 钼离子浓度与术前比较差异均无统计学意义.结论 钴铬钼合金金属对金属全髋关节及全膝关节置换术后血浆钴、铬离子浓度均高于术前,离子浓度增高趋 势相似. 6.期刊论文 王琦.张先龙.沈骏.蒋垚.邵俊杰.沈灏.曾炳芳 "低风险"人群初次人工关节置换术后的深静脉血栓 -中 华骨科杂志2007,27(2) 目的 研究"低风险"人群在人工髋、膝关节置换术后深静脉血栓的发生情况.方法 2003年2月至2005年4月,准备行选择性初次人工关节置换术的"低风 险"患者136例,其中全髋关节置换术73例76髋,全膝关节置换术63例72膝,年龄46～84岁,平均68.5岁.具有深静脉血栓高危因素的患者排除在研究之外.患 者术后均未采用任何方法预防深静脉血栓,于术后6～8天行静脉造影或根据临床表现急诊行静脉造影.怀疑肺栓塞的患者摄胸部X线片及CT加以确诊.结果 全髋关节置换术73例76髋中,22髋(28.95%)发生深静脉血栓,其中近端栓塞14髋,远端栓塞8髋;全膝关节置换术63例72膝中,33膝(45.83%)发生深静脉血栓 ,其中9膝为近端栓塞,24膝为远端栓塞.全髋关节置换组与全膝关节置换组的深静脉血栓发生率比较,差异有统计学意义(x2=4.515,P＜0.05);两组间近端 血栓发生率比较,差异无统计学意义(x2=0.988,P＞0.05);两组间远端血栓的发生率比较,差异有统计学意义(x2=11.348,P＜0.05).发生肺栓塞1例 (0.74%).临床症状对深静脉血栓的阳性预测值为52%.结论 初次人工关节置换术后"低风险"人群深静脉血栓的发生率为37.16%,而临床表现并不能作为诊 断深静脉血栓的可靠依据.临床上应建立起一套安全有效的方法降低深静脉血栓的发生. 7.期刊论文 田华.宋飞.张克.刘岩.TIAN Hua.SONG Fei.ZHANG Ke.LIU Yan 阿司匹林预防关节置换术后血栓栓塞性 疾病的疗效和安全性研究 -中华医学杂志2007,87(47) 目的 探讨阿司匹林对预防人工关节置换术后静脉血栓的疗效和安全性.方法 回顾行全膝和全髋关节置换的240例患者.其中全膝关节置换157例,全髋 关节置换83例.分为两组,甲组100例,于术后第1天起给予阿司匹林抗凝;乙组140例,给予低分子肝素抗凝.通过观察比较下肢深静脉血栓、肺栓塞、心脑血 管意外的发生率和出血、感染的发生情况,评价阿司匹林在人工关节置换术后预防血栓栓塞性疾病的疗效和安全性.结果 甲组使用阿司匹林术后出现深静 脉血栓13例(13.0%),有症状深静脉血栓7例(7.0%),疑诊肺栓塞3例(3%),心脑血管意外2例(2%);乙组出现深静脉血栓、有症状的深静脉血栓、疑诊肺栓塞 和心脑血管事件分别为10例(7.1%),4例(2.9%),3例(2.1%),8例(5.7%),两组差异均无统计学意义(P值分别为0.129、0.130、0.675、0.156).阿司匹林组术 后出血量、血红蛋白下降量、血肿发生率、感染发生率分别是(693±480)ml、(32.9±18.0)g/L、1例(1%)、0例(0%),LMWH组分别是(649±521)ml、 (36.4±21.9)g/L、3例(2.1%)、2例(1.4%),两组之间差异均无统计学意义(P值分别为0.501、0.177、0.495、0.230).结论 阿司匹林和低分子肝素对关节 置换术后静脉血栓栓塞疾病的预防疗效相近,出血和感染风险无明显区别.阿司匹林口服给药方便、费用低、患者依从性好、无需监测并对术后心脑血管 事件有良好的预防作用.阿司匹林可作为人工关节置换术后预防静脉血栓常规

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之一. 8.期刊论文 赵亚珍.周鲜花 人工全髋关节置换术后深静脉血栓形成的护理干预 -临床护理杂志2008,7(4) 目的 探讨系统护理干预对全髋关节置换术后下肢深静脉血栓形成(DVT)发生率的影响.方法 将80例接受人工全髋关节置换术患者随机分为观察组和 对照组,各40例,观察组给予术前健康知识宣教,包括饮食、功能锻炼的方法、术后早期进行主动与被动功能锻炼等,对照组采用常规护理.结果 人工全髋 关节置换术后DVT发生率观察组低于对照组,有显著性差异(P<0.05).结论 术前、术后积极的护理干预能有效降低全髋关节置换术后DVT的发生率,改善预 后. 9.期刊论文 王效

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