股骨髓腔吸引对全膝关节置换术中减少栓塞的影响

Effect of femoral canal suction on reducing embolism during total knee arthroplasty

目的评价股骨髓腔负压吸引在全膝关节置换术中减少栓塞的作用。方法通过前瞻性研究,将2009年4月到2009年9月拟行初次单侧TKA的30例骨关节炎患者作为试验组,术中采用股骨髓腔吸引,将2008年2月到2008年10月行初次单侧TKA的29例骨关节炎患者作为对照组,术中未采用髓腔负压吸引。两组患者均采用经食道超声心动图监测右心房评估术中栓子产生情况。评价指标为术中栓子形成数量(总栓子面积与右心房面积的百分比,%Ae)、相应时间点的血流动力学指数以及肺栓塞发生数。结果在TKA术中,两组患者心率、平均动脉压、氧饱和度、二氧化碳分压无统计学差异,止血带释放后5分钟时试验组氧分压高于对照组(P<0.05)。两组患者在股骨髓内定位后开始监测到栓子,在整个监测时间窗内试验组栓子%Ae均低于对照组,在释放止血带后3′内,差异有统计学意义(P<0.05)。两组均无肺栓塞病例。结论全膝关节置换术中在股骨髓内定位后开始在血液循环中监测到栓子,股骨髓腔负压吸引能够明显减少骨髓入血,有效减少栓子数量,操作简单,值得在临床上推广应用。

Objective To determine the effect of femoral canal suction on reducing embolism during total knee arthroplasty （TKA）. Methods It was a prospective study compared with a retrospective evaluation of a matched cohort. Thirty patients undergoing primary TKA during April to September 2009 were treated as study group,with femoral canal suction,and 29 undergoing primary TKA during February to October 2008 were treated as control group,without femoral canal suction. The area of embolus （%Ae,total embolus area/total right atrium area）,hemodynamics at different time points and the number of pulmonary embolism （PE） were evaluated. %Ae was evaluated by transesophageal echocardiography （TEE） during the operation. Results There was no significant difference in heart rate,mean artery pressure,SaO2 and PaCO2 between the two groups. PaO2 was significant higher after 5 min of tourniquet release in the study group than in the control group. Emboli were observed after the insertion of the rod of the intramedullary femoral guide in both the two groups. %Ae was always higher in the study group than in the control group during the monitoring period. Three min after the release of the tourniquet,there was significant difference （P〈0.05）. No pulmonary embolus was detected in the two groups. Conclusion Emboli were observed after the insertion of the rod of the intramedullary femoral guide during TKA. Femoral canal suction can significantly reduce the amount of bone marrow into the blood,effectively reducing the emboli.