脉冲冲洗在骨水泥型全膝关节置换术中的应用效果

Application of pulse irrigation in cemented total knee arthroplasty

目的探讨骨水泥型全膝关节置换术中应用脉冲冲洗对患者术后炎性反应、血栓指标及伤口愈合情况的影响。方法选取武汉大学人民医院骨二科2014年9月~2015年9日因膝关节骨性关节炎行单侧骨水泥型全膝关节置换术的患者64例,采用随机数字表法分为两组,实验组32例（术中应用脉冲冲洗）和对照组32例（术中应用普通球囊冲洗）。检测并比较两组患者在不同时间点的肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、D-二聚体水平;术后行双下肢深静脉彩超检查,比较两组患者的下肢深静脉血栓发生率;观察两组患者术后伤口愈合情况并记录伤口拆线时间。结果实验组患者在术后第1、6天血液检测中TNF-α、IL-6水平均低于对照组,差异有统计学意义（P〈0.05）;实验组患者在术后第4天D-二聚体含量、双下肢深静脉血栓发生率均低于对照组,差异有统计学差异（P〈0.05）;实验组患者伤口渗血的发生率及平均拆线时间少于对照组,差异有统计学意义（P〈0.05）。结论骨水泥型全膝关节置换术中应用脉冲冲洗可有效减轻术后炎症,降低深静脉血栓等并发症的发生率,促进伤口愈合,值得临床推广使用。

Objective To investigate the effect of pulse irrigation application in cemented total knee arthroplasty on the inflammatory reaction, thrombus index and wound healing. Methods 64 patients with knee osteoarthritis who underwent unilateral total knee arthroplasty in Renmin Hosptial of Whuan University from September 2014 to September 2015 were selected and randomly divided into the experimental group（given pulse irrigation during operation） and the control group（given common balloon irrigation during operation）, each group had 32 patients. The levels of TNF-α, IL-6,D-D of the two groups were compared at different time points. All patients underwent lower extremity vascular ultrasound examination after operation, and the incidence of lower extremity deep venous thrombosis（DVT） was compared between the two groups. The degree of wound healing of all patients, and the average time of taking out stitches in two groups were observed. Results The levels of TNF-α and IL-6 at 1 and 6 days after operation, the D-D level at 4 days after operation and the incidence of DVT in the experimental group were significantly lower than those in the control group（P〈 0.05）. The incidence of wound bleeding and the average time of taking out stitches in the experimental group were significantly lower than those in the control group（P〈 0.05）. Conclusion Application of pulse irrigation in cemented total knee arthroplasty can reduce the inflammation and the incidence of deep vein thrombosis after surgery.It can also promote the healing of the wound and would be worthy of clinical promotion.