摘要
[目的]探讨初次全膝关节置换术后肢体肿胀的相关影响因素,进一步指导并完善患者术后肢体康复训练。[方法]对2007年10月～2009年8月接受全膝关节置换术的286例患者进行回顾性分析,比较不同性别、年龄、身高体重指数(BM I)、双下肢静脉血栓(DVT)、术后抗凝方式、手术时间、围手术期血红蛋白变化、假体类型等对术后肢体肿胀程度的影响。[结果]比较BM≤I25 kg/m2患者与BM I>25 kg/m2患者全膝关节置换术后膝上10 cm周径变化值时发现两者差异不具有统计学意义(P=0.102),而在膝下10 cm周径变化值两者差异具有统计学意义(P=0.043);根据年龄分为≤60岁、60～70岁和>70岁三组,三组间术后肢体肿胀差异无统计学意义(P>0.05);性别、抗凝方式、有无下肢静脉血栓(DVT)及假体类型等对术后肢体肿胀均无显著影响(P>0.05)。将手术时间与肢体肿胀程度进行Pearson相关分析,发现两者相关性均无统计学意义(P>0.05)。二分变量线性回归分析结果表明,TKA术后肢体肿胀的影响因素包括身高体重指数(BM I)及围手术期血红蛋白变化值。[结论]①初次全膝关节置换术后肢体肿胀,以3～5 d为著,与术后早期隐性失血有关,应持续关注患者血色素的变化。②下肢的肿胀程度与患者身高体重指数、围手术期血红蛋白变化呈相关性。③TKA术后下肢肌间静脉丛血栓对远端肢体肿胀程度影响不大。
[Objective]To investigate the related factors for limb swelling after primary total knee arthroplasty,in order to guide and improve rehabilitation of patients in our clinical practice.[Methods]Using our hospital database,we retrospectively studied the mean changes in limb circumferences of 286 consecutive patients who underwent primary total knee arthroplasty（TKA） between October 2007 and August 2009.We analyzed the effect of patient age,sex,body mass index（BMI）,deep vein thrombosis（DVT）,postoperative anticoagulation method,operation time,types of prosthesis on postoperative limb swelling,and the predictive value of limb swelling.[Results]The postoperative limb swelling above the knees was higher in the patients whose BMI was lower.Low molecular weight heparin was choosen for postoperative DVT prevention（P0.05）.There was no significant difference for the postoperative limb swelling between male and female patients or between the patients who chose low molecular weight heparin for postoperative DVT prevention and the patients who chose aspirin（P0.05）.The postoperative limb swelling was similar in three age groups（P0.05）.Deep vein thrombosis（DVT） was not associated with a significant increase in postoperative limb swelling（P0.05）.There was no significant difference between open-box and closed-box prosthesis type（P0.05）.We found no significant correlation between operating time and limb swelling by Pearson correlation analysis（P0.05）.Binary linear regression analysis showed that,the impact factors of postoperative limb swelling includes body mass index（BMI） and perioperative hemoglobin values.[Conclusion]①After primary total knee arthroplasty,limbs swelling occurred,especially within 3～5 days,which was related to early postoperative hidden blood loss.Doctors should pay attention to changes of hemoglobin.②Lower extremity swelling was possitirely correlaled with body mass index and perioperative hemoglobin values.③Myenteric plexus thrombosis of lower extremities after TKA has little effect on the distal limb swelling.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2011年第9期724-727,共4页
Orthopedic Journal of China
