摘要
目的探讨骨水泥型全髋关节置换(total hip arthroplasty,THA)术后血肿形成的原因及相应的处理措施,以最大限度减少并发症。方法对2000年3月～2006年10月收治的103例骨水泥型THA患者进行对比研究,其中男44例,女59例;年龄36～89岁,平均55.3岁。股骨颈骨折49例(均为Garden4型),股骨头无菌性坏死26例(均为Ficat4期),骨关节炎28例(均为Tonnis3期)。病程1d～8年,术前Harris评分19～48分,平均36分。2000年3月～2003年12月收治的43例按常规THA术进行操作(A组);2004年1月～2006年10月收治的60例在常规THA的基础上,采用术中缝扎外旋肌断端、拔管后加压包扎、延长术后卧床时间等改进方法(B组)。结果A组术后9例假体周围发生血肿,9例抽出积血量为110～410ml,平均317.8±75.3ml;第1次抽出积血量为50～125ml,平均86.7±30.7ml;抽血2～7次,平均4.2次。B组术后2例假体周围发生血肿,2例抽出积血量分别为110ml和160ml;第1次抽出积血量分别为40ml和60ml;抽血3次和4次。两组比较差异有统计学意义(P<0.05)。两组术后共91例(A组39例,B组52例)获随访1.2～5.5年,平均3.7年,采用Harris评分评定髋关节功能,A组平均78分,B组85分。其中,疼痛项评分:A组A级(44分)16例,B级(40分)24例,C级(30分)3例;B组A级48例,B级12例,无C级。两组间Harris评分比较差异无统计学意义(P>0.05)。结论采用缝扎外旋肌断端、拔管后加压包扎、延长术后卧床时间等方法,可有效减少骨水泥型THA术后假体周围血肿的发生率及积血量。
Objective To explore the cause of haematoma after the cemented total hip arthroplasty （THA） and find out the way to decrease the incidence of haematoma perioperatively. Methods From March 2000 to October 2006, 103 patients were treated with the cemented THA. Among the patients, 44 were males and 59 were females with their ages ranging from 36 to 89 years, averaged 55.3 years. The femoral neck fracture （Garden 4） was found in 49 patients, avascular necrosis of the femoral head （Ficat 4） in 26, and osteoarthritis of the hip joint （Tonnis 3） in 28. Their illness course ranged from 1 day to 8 years. The average Harris score preoperatively was 36 （range, 19-48）. The patients were divided into Group A （n = 43） and Group B （n = 60）. The patients in Group A underwent the conventional surgical operations from March 2000 to December 2003 ; the patients in Group B underwent the same surgical procedures combined with additional procedures （e. g. , ligation of the external rotators before incision, use of plastic bandage after the drainage tube was pulled out, prolonged stay period in bed postoperatively） from January 2004 to October 2006. Results In Group A, postoperative haematoma occurred in 9 patients and the averaged 317.8±75.3 ml （range, 110- 410 ml） of the accumulated blood was drained with a syringe. An average amount for the first drainage of the accumulated blood was 86.7 ±30.7 ml （range, 50-125 ml）, and an average drainage time was 4.2（range, 2-7）. In Group B, postoperative haematoma occurred in 2 patients, with an amount of 110 ml and 160 ml of the accumulated blood and an amount of 40 ml and 60 ml of the drained blood at the first drainage. There was statistical difference in the amount of heamotoma between two groups（P〈0. 05）. The follow-up of 91 patients （39 in Group A, 52 in Group B） for 1.2-5.5 years （average, 3.7 years） revealed that the Harris scores were 78 in Group A and 85 in Group B on average. The Harris score for pain was 44 （Grade A） in 16 patients, 40 （Grade B） in 24 patients, and 30 （Grade C） in 3 patients in Group A; Grade A in 48 patients, Grade B in 12 patients, and Grade C in none of the patients in Group B. There was no statistical difference in Harris score between the two groups （P 〉 0.05）. Conclusion Additional surgical procedures for the cemented THA, such as ligation of the external rotators before incision, use of plastic bandage after the drainage tube is pulled out, and prolonged stay in bed postoperatively, can greatly help to reduce the incidence of postoperative haematoma and the amount of the accumulated blood.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2007年第10期1054-1056,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
骨水泥型全髋关节置换术
术后血肿
预防
Cemented total hip arthroplasty Postoperative haematoma Prevention
