减少全膝关节置换术中开盒假体围术期出血量的研究分析

Analysis on the blood loss reduction of open-box prosthesis in total knee arthroplasty

目的明确通过鸡尾酒灌注及髁间窝骨面骨蜡封闭等手段能否降低开盒假体的全膝关节置换术(total knee arthroplasty,TKA)围术期出血量。方法回顾性选取2019年1月至2019年12月,清华大学附属北京清华长庚医院行TKA治疗的109例患者,其中男23例,女86例,平均年龄(68.2±6.9)岁;根据假体髁间窝形态设计的不同分为闭盒组及开盒组,其中闭盒组53例,平均年龄(68.2±6.4)岁,开盒组56例,平均年龄(68.3±7.1)岁。分析两组患者术后血红蛋白及围术期出血量的差异。结果闭盒组术后第1天及第3天血红蛋白分别为(123.60±11.08)g/L及(110.96±12.48)g/L,开盒组术后第1天及第3天血红蛋白分别为(128.36±12.79)g/L及(112.52±12.93)g/L,截至术后第3天总失血量,开盒组为(571.39±305.66)ml,闭盒组为(552.42±302.59)ml,所有结果在两组间差异均无统计学意义(P>0.05)。结论通过骨蜡封闭及关节腔灌注鸡尾酒处理后,开盒式假体与闭盒式假体的TKA围术期出血量差异无统计学意义,因此,对于开盒式假体的TKA采用本研究中提及的处理方案,在失血量等方面可获得完全不亚于闭盒式假体TKA的结果。

Objective To determine whether the perioperative TKA blood loss of open-box prosthesis can be reduced by intraarticular Cocktail Injection and intercondylar fossa bone wax sealing.Methods A total of109 patients who underwent total knee arthroplasty from January 2019 to December 2019 at Beijing TsingHuaChanggung Hospital were analyzed,including 23 males and 86 females with an average age of(68.2±6.9)years.According to the different shape designs of the prosthesis intercondyle fossa,they were divided into the closed-box group[n=53;averaged(68.2±6.4)years]and open-box group[n=56;averaged(68.3±7.1)years].The differences of hemoglobin and perioperative blood loss between the two groups were analyzed.Results The HB of the closed-box group was(123.60±11.08)g/L and(110.96±12.48)g/L on the first and third days after surgery,and that of the open-box group was(128.36±12.79)g/L and(112.52±12.93)g/L.The total blood loss by the 3rd day after surgery was(571.39±305.66)ml in the open-box group and(552.42±302.59)ml in the closed-box group.All the results showed no statistically significant differences between the two groups(P>0.05).Conclusions No obvious differences in blood loss are noted between open-box and closed-box prosthesis after bone wax sealing and intraarticular Cocktail Injection.Similar blood loss as closed-box prosthesis total knee arthroplasty will be reached by open-box prosthesis arthroplasty using treatment scheme mentioned in this study.