初次全膝关节置换术后隐性失血的影响因素研究

Impact factors for hidden blood loss after primary total knee arthroplasty

目的探讨初次全膝关节置换术（TKA）术后隐性失血的相关影响因素。方法回顾性分析2007年10月至2009年8月接受初次TKA的422例患者，男性60例，女性362例；年龄18～84岁，平均65．7岁。根据Ward和Gross的方法计算隐性失血量。分析性别、年龄、体质量指数（BMI）、单双侧手术、下肢深静脉血栓、术后抗凝方式、止血带使用时间、假体类型等对术后隐性失血的影响。结果接受单膝TKA与一期双膝TKA的患者术后隐性失血量分别为（1284±207）ml和（2248±504）ml，差异有统计学意义（P=0．000）。单因素分析显示：BMI、止血带使用时间、假体类型及抗凝方式与TKA术后隐性失血有关。多元线性回归分析结果表明，TKA术后隐性失血的影响因素包括BMI、止血带使用时间及假体类型。结论BMI、一期双膝关节置换、止血带使用时间及假体类型是TKA术后隐性失血量的影响因素，而性别、年龄、诊断、下肢深静脉血栓及抗凝方式对术后隐性失血形成的影响不大。

Objective To investigate the relative factors for hidden blood loss （HBL） after primary total knee arthroplasty （TKA）. Methods A retrospective study of 422 consecutive patients who underwent primary TKA between October 2007 and August 2009 was carried on. There were 60 male and 362 female patients with a mean age of 65.7 years. The HBL was calculated according to Gross formula. The effect of patient gender, age, body mass index （BMI）, pre-operative diagnosis, unilateral or simultaneous bilateral TKA, tourniquet time, type of prosthesis, postoperative anticoagulation method and deep vein thrombosis （DVT） on the postoperative HBL were analyzed. Results The HBL in patients underwent unilateral TKA was significantly lower than that in those underwent simultaneous bilateral TKA [ （ 1284± 207 ） ml vs. （2248 ± 504 ） ml, P = 0. 000 ]. Unvaried analysis showed that the HBL were associated with BMI, tourniquet time, prosthesis type and postoperative anticoagulation method. Multivariate linear regression analysis showed that the impact factors of postoperative HBL include BMI, tourniquet time and prosthesis type. Conclusions BMI, bilateral simultaneous TKA, tourniquet time and intercondylar open prosthesis impact the HBL after primary TKA. However, the influence of gender, age, diagnosis, postoperative anticoagulation method and DVT on the HBL are not significant.