人工全膝关节置换术中滑膜处理方式对术后感染的影响

Effect of synovial membrane treatment methods on postoperative infection in total knee arthroplasty

目的探讨人工全膝关节置换术中滑膜处理方式对术后感染的影响,为临床诊治提供依据。方法依据人工全膝关节置换术中滑膜切除与否将医院2013年1月-2015年10月收治的158例膝骨关节炎患者分为切除组65例与保留组93例,比较两组患者手术时间、出血情况及手术效果,同时手术前后对两组患者炎症反应相关指标测定比较,统计两组术后感染率。结果切除组手术时间、术中出血量、术后引流量均明显多于保留组(P<0.05);切除组术后输血率41.54%显著高于保留组17.20%(P<0.05);与同组术前1d比较,两组术后1d、2周血清C-反应蛋白(CRP)、总白细胞计数、白介素-6(IL-6)均显著上升(P<0.05),术后12周、1年上述指标与术前1d比较差异无统计学意义;两组浅表感染发生率比较差异无统计学意义,而深部感染发生率(4.62%vs 0)比较差异有统计学意义(P<0.05);与同组术前1d比较,两组术后4周、术后1年AKSS临床评分、AKSS功能评分均显著上升(P<0.05)。结论人工全膝关节置换术中切除滑膜与否对患者炎症反应、患肢功能恢复无明显影响,但滑膜切除会显著增加出血量及术后输血率,延长手术时间,且可能增加术后感染的发生。

OBJECTIVE To investigate the effect of synovial membrane treatment methods on postoperative infection in total knee arthroplasty,so as to provide references for clinical diagnosis and treatment.METHODS A total of 158 patients with knee osteoarthritis who were admitted to the hospital from Jan.2013 to Oct.2015 were divided into resection group （n=65） and preservation group （n=93） according to whether the synovial membrane was removed in total knee arthroplasty.The operation time,blood loss and operation effects were compared between the two groups,and the related indexes of inflammatory reactions in the two groups were compared before and after operation.The postoperative infection rates in the two groups were statistically analyzed.RESULTS The operation time,intraoperative blood loss and postoperative drainage volume of resection group were significantly longer and more than those of preservation group （P〈0.05）.The rate of postoperative blood transfusion of resection group was 41.54%,which was significantly higher than 17.2% of preservation group （P〈0.05）.Compared with the same group 1d before operation,the serum C reactive protein （CRP）,total white blood cell count and interleukin6 （IL-6） increased significantly at 1d and 2 weeks after operation （P〈0.05）,and the these indexes showed no significant differences at 12 weeks and 1 year after operation.There was no significant difference in the superficial infection rate between the two groups,while the deep infection rate （4.62% vs 0.00%） showed significant differences （P〈0.05）.Compared with the same group 1d before operation,the AKSS clinical scores and AKSS function scores increased significantly at 4 weeks and 1 year after operation （P〈0.05）.CONCLUSION The removal of synovial membrane or not in total knee arthroplasty has no obvious effect on inflammatory reactions and recovery of the affected limbs.However,the removal of synovial membrane will significantly increase blood loss and postoperative blood transfusion rate,and prolong operation time,which may increase the incidence of postoperative infection.