膝骨性关节炎分级与全膝关节置换后隐性失血

Knee osteoarthritis grading affects the hidden hemorrhage after total knee arthroplasty

背景:人工膝关节置换的对象群体年龄偏高,常伴有高血压病、糖尿病等基础性疾病,身体条件较差,所以围置换期失血成为影响置换安全的重要影响因素。目的:分析初次行人工膝关节置换围置换期的隐性失血量,以及根据膝骨性关节炎严重程度对围置换期出血量进行置换前评估的方法。方法:对行人工膝关节置换的膝骨性关节炎患者126例进行回顾性分析,根据Kellgren和Lawrecne影像学分级把患者分为Ⅲ级组与Ⅳ级组,对两组患者的隐性失血量进行统计学分析。结果与结论:纳入患者平均总失血量1560mL,其中隐性失血量865mL(55%),Ⅲ级组平均总失血量1290mL,其中隐性失血量684mL(占总失血量53%),Ⅳ级组平均总失血量1644mL,其中隐性失血量921mL(占总失血量56%),对两组数据进行统计学分析比较,在平均总失血量与隐性失血量上差异有显著性意义(P<0.05),而在隐性失血所占比例上差异无显著性意义。结果提示膝骨性关节炎影像学分级等级越高,人工全膝关节置换围置换期平均总失血量和隐性失血量越大,而隐性失血的比例变化不明显。对不同严重程度的膝骨性关节炎患者进行关节置换前出血量预测评估,对加强患者围置换期血液管理及保证患者生命安全有积极意义。

BACKGROUND： The patients receiving total knee arthroplasty are high in average age, and often accompanied with hypertension, diabetes and other basic diseases. Due to the poor physical conditions of the patients, perioperative hemorrhage becomes the important factor that affecting the safety of replacement. OBJECTIVE： To analyze perioperative hidden hemorrhage of primary total knee arthroplasty, and to explore the method of evaluating perioperative blood loss by osteoarthritis severity before total knee arthroplasty. METHODS： A retrospective analysis of 126 knee osteoarthritis patients undergoing total knee arthroplasty was conducted. All the patients were divided into two groups according to Kellgren and Lawrecne imaging classification： stage III group and stage N group. The hidden hemorrhage of the patients in two groups was calculated. RESULTS AND CONCLUSION： The average total blood loss of the patients was 1 560 mL, included hidden hemorrhage 865 mL （55%）. The mean blood loss of stage ]]/ group was 1 290 mL with the mean hidden hemorrhage of 684 mL （53%）. The mean blood loss of stage N group was 1 644 mL with the mean hidden hemorrhage of 921 mL （56%）. Statistical analysis showed there were significant differences of total blood loss and hidden hemorrhage between two groups （P 〈 0.05）, but there was no significant difference in the percentage of hidden hemorrhage. The results indicate that higher grade of osteoarthritis imaging classification, the more of total blood loss and hidden hemorrhage, while the change of the percentage of hidden hemorrhage is not significant. Preoperative evaluation of patients＇ blood loss by osteoarthritis severity has great significance for blood management and surgical safety of patients.