脉冲冲洗器在髋关节置换术中的应用研究

Application of pulse irrigator in hip arthroplasty

目的:探讨脉冲冲洗器在人工全髋关节置换术中应用对术后并发症的影响。方法:选取2011年4月至2013年10月在同济医院骨科关节置换中心进行髋关节置换手术患者共72例,其中男性患者19例,女性患者53例,随机选取关节置换手术中应用脉冲冲洗器的36例患者作为实验组;术中采用普通方式冲洗(未用脉冲冲洗器)方法的36例患者作为对照组。对两组病例术后记录并比较脂肪栓塞情况与深静脉血栓、伤口愈合情况、术后7 d内患者发热情况、术后X线片观察与假体松动率的关系进行观察。结果:被纳入的72例患者中,脂肪栓塞与深静脉血栓的发生率比较:实验组36例患者中,均未发现脂肪栓塞及下肢深静脉血栓;在对照组的36例患者中,发现1例深静脉血栓病例,未见脂肪栓塞的发生。术后伤口愈合情况:实验组36例患者术后伤口愈合情况,甲级伤口36例,甲级愈合率100.00%;对照组甲级伤口34例,甲级愈合率94.44%,提示实验组较对照组伤口愈合情况好。术后7天内患者发热情况:实验组36例患者中出现1例发热患者;对照组36例患者中出现3例发热患者。实验组比对照组术后7天内发热情况较好。对72例患者分别在术后2周、3月、6月、1年和1.5年时X线片观察术后假体是否有松动情况,实验组36例患者术后X片检查,假体位置正常,骨粘合界面较好,无假体松动下沉等情况;对照组有2例出现X线片表现股骨柄骨水泥与骨髓腔壁间隙增大,1例在术后一年时发现,另外1例是在术后1.5年时发现。结论:在髋关节置换手术中,应用脉冲冲洗器能有效预防术后深静脉血栓形成及脂肪栓塞,减少术后假体松动的发生,利于伤口愈合,避免术后伤口感染不愈合、术后发热等术后并发症,有利于患者术后早日下床科学功能锻炼。对关节置换手术术后并发症的预防有肯定效果,有价值进一步对脉冲冲洗器进行研究和推广。

Objective:To investigate the effect of pulse irrigator on postoperative complications in hip arthroplasty.Methods:A total of 72 patients performed hip arthroplasty in Tongji Hospital from April 2011 to October 2013were selected,with 19 male patients and 53 female patients.Among them,36 patients who used pulse irrigator were randomly selected as experimental group;36 patients who used regular washing method were selected as control group.The fat embolism,deep vein thrombosis,wound healing,fever within 7 days after surgery,postoperative X-ray observation and prosthesis loosening rate were observed in the two groups.Results:Among the 72 patients,the incidence of fat embolism and deep vein thrombosis was compared.Among the 36 patients in the experimental group,no fat embolism or deep vein thrombosis in the lower extremity was found.Among the 36 patients in the control group,1 case of deep vein thrombosis was found without fat embolism.Thirty-six patients in the experimental group have grade A postoperative wound healing,with wound healing rate being 100.00%.There were 34 cases have grade A wounds in the control group with the wound healing rate was 94.44%,suggesting that the experimental group had better wound healing than the control group.One of 36 patients in the experimental group had fever within 7 days after surgery;3 of the 36 patients in the control group had fever.The experimental group was better than the control group in fever occurrence.X-ray examination was performed on 72 patients 2 weeks,3 months,6 months,1 year and 1.5 years after surgery to observe whether the prosthesis was loose.The results showed that the position of the prosthesis was normal,the bone bonding interface was good,and there was no loosening or subsidence in the experimental group.In the control group,2 patients presented increased gap between femoral shaft bone cement and bone marrow cavity wall.One case was found one year after surgery,and the other case was found 1.5 years after surgery.Conclusion:In hip replacement surgery,the application of pulse irrigator can effectively prevent postoperative deep vein thrombosis and fat embolism,reduce the occurrence of postoperative prosthesis loosening,facilitate wound healing,and avoid postoperative wound infection.Postoperative complications such as postoperative fever are beneficial to the early postoperative clinical function of the patient.It has a positive effect on the prevention of complications after joint replacement surgery,and it is worthwhile to further research and popularize the pulse irrigator.