骨水泥封堵股骨髓腔对全膝关节置换术围手术期失血量的影响

Effect of using bone cement sealing femoral marrow cavity on perioperative blood loss of total knee arthroplasty

目的探讨骨水泥封堵股骨髓腔对全膝关节置换术(TKA)围手术期失血量的影响。方法回顾性分析陕西省人民医院2014年1月至2016年12月因骨关节炎行单侧初次TKA的患者173例,具有完整的影像学资料、血液学检验报告且伴发疾病不影响凝血或血流动力学的患者共116例,其中男53例,女63例,年龄平均(64±5)岁。65例患者使用自体截骨块制成的塞子填塞股骨髓腔口(A组),51例患者在使用自体骨塞的基础上采用面团期骨水泥封堵残存的股骨髓腔裂隙(B组)。采用卡方检验比较两组患者的性别、麻醉方式、异体输血率及深静脉血栓(DVT)发生率,采用独立样本t检验比较两组患者的年龄、身体质量指数(BMI)、手术时间、术中出血量、截骨厚度、术后引流量及围手术期显性出血量及隐性出血量。结果所有患者均顺利完成手术,两组患者在性别(X^22=0.161,P>0.05)、年龄(t=-8.38,P>0.05)、BMI(t=1.837,P>0.05)、麻醉方式(X^22=0.91,P>0.05)、手术时间(t=1.714,P>0.05)及截骨厚度(t=0.448,P>0.05)方面差异无统计学意义。A组的显性出血量为(237.7±58.7)ml,B组的显性出血量为(225.5±68.1)ml,2组之间差异无统计学意义(P>0.05);A组的隐性出血量为(624.6±77.1)ml,B组的隐性出血量为(543.1±63.3)ml,A组的隐性出血量明显高于B组(t=6.104,P<0.05)。A组的异体输血率为35%,B组的异体输血率为21%,经比较二者之间差异有统计学意义(X^22=4.861,P<0.05)。A组和B组下肢DVT的发生率分别为6.1%与3.9%,差异无统计学意义(P>0.05)。结论使用骨水泥封堵股骨髓腔可有效减少TKA围手术期隐性失血量。

Objective To explore the effect of using bone cement sealing femoral medullary cavity on the perioperative blood loss of total knee arthroplasty（ TKA） surgery. Methods A total of 173 cases of osteoarthritis patients,whom undergone unilateral primary TKA surgery were retrospectively analyzed from January,2014 to December,2016. Among them,116 cases of patients who had complete imaging data and hematological test reports without coagulation or hemodynamics affecting diseases were included. There were53 cases of males and 63 cases of females,with an average age of（ 64 ± 5） years. Sixty-five cases received the intervention of autologous cutting bone plug filling the femoral marrow cavity（ group A） and 51 cases accepted management of combined autologous cutting bone plug filling the femoral marrow cavity and bone cement sealing the residual femoral marrow cavity（ group B）. Chi-square test was used to compare the difference of gender,anesthesia method,rate of allogeneic transfusion and deep venous thrombosis（ DVT） of lower extremity between the two groups. Independent-samples t test was used for comparison of operation time,intraoperative blood loss,osteotomy thickness,and volume of wound drainage,dominant hemorrhage and hidden hemorrhage between the two groups. Results All the operations were completed successfully. There was no significant difference with regard to the preoperative basic information such as gender ratio（ X^2=0. 161,P 〉 0. 05）,age（ t =-8. 38,P 〉 0. 05） and body mass index（ BMI）（ t = 1. 837,P 〉 0. 05） in the two groups. No significant difference was found about the anesthesia way（ X^2= 0. 91,P 〉 0. 05）,operation time（ t = 1. 714,P 〉 0. 05）,and osteotomy thickness（ t = 0. 448,P 〉 0. 05） in the two groups. The average volume of dominant hemorrhage in group A was（ 237. 7 ± 58. 7） ml,mean volume of dominant hemorrhage in group B was（ 225. 5 ± 68. 1） ml,there was no statistical difference between the two groups（ P 〉 0. 05）. The average volume of hidden hemorrhage in group A was（ 624. 6 ± 77. 1） ml,mean volume of hidden hemorrhage in group B was（ 543. 1 ± 63. 3） ml with statistical difference（ t = 6. 104,P 〈 0. 05）. The rate of allogeneic transfusion in group A was 35% and group B was 21%,a statistical difference was observed between the two groups（ X^2= 4. 861,P 〈 0. 05）. The incidence of DVT in group A and group B were respectively 6. 1% and 3. 9%,with no statistical difference（ P 〉 0. 05）. Conclusion Using the bone cement sealing the residual femoral marrow cavity can effectively reduce the perioperative volume of hidden blood loss in TKA surgery.