膝骨关节炎是与年龄相关的慢性退行性疾病,主要影响膝关节活动,且致畸、致残率高,严重影响中老年人的生活质量。晚期膝骨关节炎主要依赖膝关节置换术达到根治目的,以阻断疾病继续发展,但由于手术创伤、活动量减少等因素,术后常遗留下肢...膝骨关节炎是与年龄相关的慢性退行性疾病,主要影响膝关节活动,且致畸、致残率高,严重影响中老年人的生活质量。晚期膝骨关节炎主要依赖膝关节置换术达到根治目的,以阻断疾病继续发展,但由于手术创伤、活动量减少等因素,术后常遗留下肢肿胀这一问题,影响关节功能恢复。西医对于该问题治疗手段较为单一,且长时间使用消肿药物具有较大副作用。近年来中医药对于患者术后下肢肿胀的研究层出不穷,可通过多模式方案对患者进行干预且疗效确切。本文综述了近五年中医药治疗膝关节置换术后下肢肿胀的临床进展,以期为中医药在治疗膝关节置换术后下肢肿胀方面提供科学依据。Osteoarthritis of the knee is an age-related chronic degenerative disease that mainly affects knee joint activities and has a high rate of deformity and disability, which seriously affects the quality of life of middle-aged and elderly people. Late-stage osteoarthritis of the knee mainly relies on knee arthroplasty to achieve the goal of eradication, in order to stop the disease from continuing to develop, but due to surgical trauma, reduced activity and other factors, the problem of lower limb swelling is often left behind after the operation, which affects the recovery of function of knee joint. Western medicine is a single treatment for this problem, and the prolonged use of anti-swelling drugs has greater side effects. In recent years, there have been numerous studies on postoperative lower limb swelling in Chinese medicine, which can intervene in patients through multi-modal programs with precise efficacy. This article summarizes the clinical progress of Chinese medicine in the treatment of postoperative lower extremity swelling after knee arthroplasty in the past five years, with a view to providing a scientific basis for the use of Chinese medicine in the treatment of postoperative lower extremity swelling after knee arthroplasty.展开更多
文摘膝骨关节炎是与年龄相关的慢性退行性疾病,主要影响膝关节活动,且致畸、致残率高,严重影响中老年人的生活质量。晚期膝骨关节炎主要依赖膝关节置换术达到根治目的,以阻断疾病继续发展,但由于手术创伤、活动量减少等因素,术后常遗留下肢肿胀这一问题,影响关节功能恢复。西医对于该问题治疗手段较为单一,且长时间使用消肿药物具有较大副作用。近年来中医药对于患者术后下肢肿胀的研究层出不穷,可通过多模式方案对患者进行干预且疗效确切。本文综述了近五年中医药治疗膝关节置换术后下肢肿胀的临床进展,以期为中医药在治疗膝关节置换术后下肢肿胀方面提供科学依据。Osteoarthritis of the knee is an age-related chronic degenerative disease that mainly affects knee joint activities and has a high rate of deformity and disability, which seriously affects the quality of life of middle-aged and elderly people. Late-stage osteoarthritis of the knee mainly relies on knee arthroplasty to achieve the goal of eradication, in order to stop the disease from continuing to develop, but due to surgical trauma, reduced activity and other factors, the problem of lower limb swelling is often left behind after the operation, which affects the recovery of function of knee joint. Western medicine is a single treatment for this problem, and the prolonged use of anti-swelling drugs has greater side effects. In recent years, there have been numerous studies on postoperative lower limb swelling in Chinese medicine, which can intervene in patients through multi-modal programs with precise efficacy. This article summarizes the clinical progress of Chinese medicine in the treatment of postoperative lower extremity swelling after knee arthroplasty in the past five years, with a view to providing a scientific basis for the use of Chinese medicine in the treatment of postoperative lower extremity swelling after knee arthroplasty.
文摘目的:观察单侧双通道内镜下腰椎融合术(unilateralbiportal endoscopic transforaminal lumbarinter-bodyfusion,UBE-TLIF)术后的隐性失血情况,并对其相关危险因素进行分析。方法:回顾性分析2020年1月~2021年6月在我院行UBE-TLIF治疗的59例腰椎退行性疾病患者的临床资料,收集患者一般资料如年龄、性别、体质指数(bodymass index,BMI)、学习曲线、疾病类型以及是否合并有高血压、糖尿病;手术相关资料如病变节段、手术时间、显性失血量、美国麻醉师协会麻醉分级(American Society of Anesthesiologists,ASA);实验室检查如凝血酶原时间、活化部分凝血活酶时间、血小板计数、纤维蛋白原、血红蛋白(hemoglobin,Hb)和红细胞压积(hematocrit,Hct)。根据Gross公式计算总失血量,并由此计算患者的术后隐性失血量,采用单因素方差分析和Pearson相关性检验探讨患者的特征与术后隐性失血之间的相关性,采用多元线性回归分析确定术后隐性失血的独立危险因素,构建危险因素的受试者工作特征(receiver operating characteristic,ROC)曲线以分析危险因素的预测价值。结果:手术时间为128.22±22.88min,总失血量为607.32±186.78ml,隐性失血量为393.83±173.42ml,占总失血量的(62.13±11.73)%。术后Hb、Hct均较术前明显降低(P<0.05)。单因素方差分析中性别、高血压、糖尿病、手术节段、疾病类型与隐性失血无明显相关性(P>0.05),学习曲线和ASA分级与隐性失血具有相关性(P<0.001)。Pearson相关性分析显示,年龄、BMI、凝血酶原时间、活化部分凝血活酶时间、血小板计数与隐性失血无相关性(P>0.05),手术时间、纤维蛋白原与隐性失血具有相关性(P<0.001)。多元线性回归分析显示,手术时间(B=2.236,P<0.01)学习曲线(B=-109.781,P<0.01)、ASA分级(B=77.589,P<0.01)和纤维蛋白原(B=81.762,P<0.01)是隐性失血的独立危险因素。ROC曲线显示手术时间预测严重隐性失血的ROC曲线下面积(areaundercurve,AUC)为0.813(95%CI:0.688~0.938,P<0.001),最佳截点为139.5min;纤维蛋白原的AUC为0.794(95%CI:0.654~0.934,P<0.001),最佳截点为2.65g/L。结论:UBE-TLIF治疗腰椎退行性疾病存在较大的术后隐性失血,手术时间、学习曲线、ASA分级和纤维蛋白原是术后隐性失血的独立危险因素。
