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

doi:10.3877/cma.j.issn.1674-134X.2018.03.008

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(χ²＝0.161，P >0.05)、年龄(t＝－8.38，P >0.05)、BMI(t＝1.837, P >0.05)、麻醉方式(χ²＝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(χ²＝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。

关键词: 膝, 骨关节炎, 关节成形术, 出血, 输血

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 were 53 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 (χ²=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 (χ²=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 (χ²=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.

Key words: Knee, Osteoarthritis, Arthroplasty, Hemorrhage, Blood transfusion

表1 患者基本资料比较(±s)

?	例数	性别(男/女)	年龄(岁)	BMI(kg/m²)	病程(年)	Hb(g/L)	HCT
A组	65	24/41	64.10±5.20	28.60±4.70	8.00±4.00	121.90±6.60	0.37±0.02
B组	51	17/34	65.00±5.60	26.90±4.40	6.70±3.00	124.30±6.50	0.36±0.02
统计值	?	χ²＝0. 161	t ＝－8.38	t ＝1.837	t ＝－1. 940	t ＝－1.943	t ＝1.708
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表1 患者基本资料比较(±s)

?	例数	性别(男/女)	年龄(岁)	BMI(kg/m²)	病程(年)	Hb(g/L)	HCT
A组	65	24/41	64.10±5.20	28.60±4.70	8.00±4.00	121.90±6.60	0.37±0.02
B组	51	17/34	65.00±5.60	26.90±4.40	6.70±3.00	124.30±6.50	0.36±0.02
统计值	?	χ²＝0. 161	t ＝－8.38	t ＝1.837	t ＝－1. 940	t ＝－1.943	t ＝1.708
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表2 两组手术时计量资料比较(±s)

分组	例数	手术时间(min)	股骨截骨厚度(mm)	显性失血量(ml)
A组	65	71.1±6.5	9.5±1.1	237.7±58.7
B组	41	73.4±8.3	9.5±0.8	225.5±68.1
t值	?	－1.714	0.448	1.035
P值	?	>0.05	>0.05	>0.05

表2 两组手术时计量资料比较(±s)

分组	例数	手术时间(min)	股骨截骨厚度(mm)	显性失血量(ml)
A组	65	71.1±6.5	9.5±1.1	237.7±58.7
B组	41	73.4±8.3	9.5±0.8	225.5±68.1
t值	?	－1.714	0.448	1.035
P值	?	>0.05	>0.05	>0.05

表3 两组评价指标的计数资料比较(±s)

分组	麻醉方式比例	异体输血率^*	DVT发生率
A组	50∶15	35%	6.1%
B组	38∶13	21%	3.9%
χ²值	0.910	4.861	0.381
P值	>0.05	<0.05	>0.05

表3 两组评价指标的计数资料比较(±s)

分组	麻醉方式比例	异体输血率^*	DVT发生率
A组	50∶15	35%	6.1%
B组	38∶13	21%	3.9%
χ²值	0.910	4.861	0.381
P值	>0.05	<0.05	>0.05

图1 两组隐性失血量随时间变化对比图。*－　两组比较差异有统计学意义(P <0.05)

表4 两组术后隐性失血量比较[ml，(±s)]

分组	第1天	第2天	第3天	第7天	第14天
A组	224±78	341±82	418±79	498±72	625±77
B组	205±80	315±90	377±65	421±56	543±63
t值	1.307	1.727	2.854	6.353	6.104
P值	>0.05	>0.05	<0.05	<0.05	<0.05

表4 两组术后隐性失血量比较[ml，(±s)]

分组	第1天	第2天	第3天	第7天	第14天
A组	224±78	341±82	418±79	498±72	625±77
B组	205±80	315±90	377±65	421±56	543±63
t值	1.307	1.727	2.854	6.353	6.104
P值	>0.05	>0.05	<0.05	<0.05	<0.05

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

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