膝关节骨性关节炎患者人工全膝关节置换术中滑膜切除与术后感染的关系
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摘要
目的探讨膝关节骨性关节炎患者人工全膝关节置换术中滑膜切除与术后感染的关系。方法选择121例行人工全膝关节置换术的患者为观察对象,分为滑膜切除的切除组63例,未切组58例。随访2年,比较手术前后两组的膝关节临床和功能KSS评分及VAS疼痛评分;记录并比较两组的手术时间、住院天数、引流量。比较血沉、C反应蛋白、白细胞计数等感染指标以及术后感染情况。结果比较两组患者手术前、术后4周及术后1年的KSS临床评分、KSS功能评分、疼痛VAS评分,发现两组间差异无统计学意义。两组患者组内比较,VAS疼痛评分在术后4周及术后1年均低于术前,而膝关节KSS临床和功能分则高于术前(P<0.05)。切除组的手术时间、术中出血量、术后引流量均高于未切组(P<0.05),手术前后的血沉、血清CRP(C-反应蛋白,C-reaction protein,CRP)水平及白细胞计数在两组间的比较差异均无统计学意义。两组的浅表感染率之间比较差异无统计学意义,切除组的深部感染率组高于未切组。结论人工全膝关节置换术时切除滑膜与否对手术效果、炎症反应无明显影响,但会增加患者住院时间、失血量、引流量及深部感染率。
Objective To investigate the relationship between synovectomy and postoperative infection in total knee arthroplasty in patients with knee osteoarthritis. Methods A total of 121 patients who underwent total knee arthroplasty were enrolled. The patients were divided into 63 patients with synovectomy and 58 patients with uncut group. The patients were followed up for 2 years. The clinical and functional KSS scores and VAS pain scores of the knee joints were compared before and after the operation. The operation time, hospital stay and drainage volume of the two groups were recorded and compared. Compare the blood glucose, C-reactive protein, white blood cell count and other infection indicators as well as postoperative infection. Results The KSS clinical score, KSS functional score and pain VAS score of the two groups before operation, 4 weeks after operation and1 year after operation were compared. No significant difference was found between the two groups. Compared with the preoperative group, the VAS pain score was lower than that of the preoperative group(P<0.05). The operation time, intraoperative blood loss and postoperative drainage volume of the resection group were higher than those of the uncut group(P<0.05). There was no significant difference in the erythrocyte sedimentation rate,serum CRP level and white blood cell count between the two groups before and after surgery. There was no significant difference in the superficial infection rates between the two groups. The deep infection rate group in the resection group was higher than the uncut group. Conclusion The removal of synovial membrane during total knee arthroplasty has no significant effect on the surgical outcome and inflammatory response, but it will increase the hospitalization time, blood loss, drainage volume and deep infection rate.
Objective To investigate the relationship between synovectomy and postoperative infection in total knee arthroplasty in patients with knee osteoarthritis. Methods A total of 121 patients who underwent total knee arthroplasty were enrolled. The patients were divided into 63 patients with synovectomy and 58 patients with uncut group. The patients were followed up for 2 years. The clinical and functional KSS scores and VAS pain scores of the knee joints were compared before and after the operation. The operation time, hospital stay and drainage volume of the two groups were recorded and compared. Compare the blood glucose, C-reactive protein, white blood cell count and other infection indicators as well as postoperative infection. Results The KSS clinical score, KSS functional score and pain VAS score of the two groups before operation, 4 weeks after operation and1 year after operation were compared. No significant difference was found between the two groups. Compared with the preoperative group, the VAS pain score was lower than that of the preoperative group(P<0.05). The operation time, intraoperative blood loss and postoperative drainage volume of the resection group were higher than those of the uncut group(P<0.05). There was no significant difference in the erythrocyte sedimentation rate,serum CRP level and white blood cell count between the two groups before and after surgery. There was no significant difference in the superficial infection rates between the two groups. The deep infection rate group in the resection group was higher than the uncut group. Conclusion The removal of synovial membrane during total knee arthroplasty has no significant effect on the surgical outcome and inflammatory response, but it will increase the hospitalization time, blood loss, drainage volume and deep infection rate.
引文
[1] Arden NK, Leyland KM. Osteoarthritis year 2013 in review:clinical. Osteoarthritis Cartilage, 2013, 21(10):1409-1413.
[2] Cha MS, Cho SH, Kim DH, et al. Two-Stage Total Knee Arthroplasty for Prosthetic Joint Infection[J].Knee Surgery&Related Research, 2015,27(2):82-89.
[3]徐昭宁,杨旭,田少奇,等.滑膜切除对全膝关节置换术术后失血及功能恢复的影响[J].中华临床医师杂志(电子版),2013,7(4):111-114.
[4]苏星华.全膝关节置换术中滑膜切除对患者失血量及膝关节功能的影响[J].医学理论与实践,2016,44(21):108-110.
[5]邱贵兴.骨关节炎诊治指南(2007年版)[J].中华骨科杂志,2007,27(10):28-30.
[6]杨威,康武林,袁普卫,等.滑膜炎在骨关节炎发病机制中作用的研究进展[J].中国康复理论与实践,2015,21(5):530-533.
[7]丁汉飞,肖李冰,陆启祥.类风湿关节炎早期切除50例[J].中国骨伤,2002,15(3):179.
[8]华政哲,张敬东,刘贵堂,等.滑膜切除对全膝关节置换出血及临床效果的影响[J].黑龙江医药,2015,28(4):749-752.
[9] Kilicarslan K, Yalcin N, Cicek H, et al. The effect of total synovectomy in total knee arthroplasty:a prospective randomized controlled study[J]. Knee Surgery Sports Traumatology Arthroscopy, 2011,19(6):932-935.
[10] Mihalko WM, Saleh KJ, Krackow KA, et al. Soft-tissue balancing during total knee arthroplasty in the varus knee[J]. Journal of the American Academy of Orthopaedic Surgeons, 2009,17(12):766-74.
[11]张卓,雷青.感染对膝关节置换术后患者红细胞沉降率C反应蛋白及白细胞计数变化的影响[J].现代医药卫生,2015,31(9):1347-1349.
[12]高玉镭,张寅权,宋方龙,等.切除与不切除滑膜对人工全膝关节置换术后感染影响的比较[J].中国矫形外科杂志,2016,24(5):411-415.
[2] Cha MS, Cho SH, Kim DH, et al. Two-Stage Total Knee Arthroplasty for Prosthetic Joint Infection[J].Knee Surgery&Related Research, 2015,27(2):82-89.
[3]徐昭宁,杨旭,田少奇,等.滑膜切除对全膝关节置换术术后失血及功能恢复的影响[J].中华临床医师杂志(电子版),2013,7(4):111-114.
[4]苏星华.全膝关节置换术中滑膜切除对患者失血量及膝关节功能的影响[J].医学理论与实践,2016,44(21):108-110.
[5]邱贵兴.骨关节炎诊治指南(2007年版)[J].中华骨科杂志,2007,27(10):28-30.
[6]杨威,康武林,袁普卫,等.滑膜炎在骨关节炎发病机制中作用的研究进展[J].中国康复理论与实践,2015,21(5):530-533.
[7]丁汉飞,肖李冰,陆启祥.类风湿关节炎早期切除50例[J].中国骨伤,2002,15(3):179.
[8]华政哲,张敬东,刘贵堂,等.滑膜切除对全膝关节置换出血及临床效果的影响[J].黑龙江医药,2015,28(4):749-752.
[9] Kilicarslan K, Yalcin N, Cicek H, et al. The effect of total synovectomy in total knee arthroplasty:a prospective randomized controlled study[J]. Knee Surgery Sports Traumatology Arthroscopy, 2011,19(6):932-935.
[10] Mihalko WM, Saleh KJ, Krackow KA, et al. Soft-tissue balancing during total knee arthroplasty in the varus knee[J]. Journal of the American Academy of Orthopaedic Surgeons, 2009,17(12):766-74.
[11]张卓,雷青.感染对膝关节置换术后患者红细胞沉降率C反应蛋白及白细胞计数变化的影响[J].现代医药卫生,2015,31(9):1347-1349.
[12]高玉镭,张寅权,宋方龙,等.切除与不切除滑膜对人工全膝关节置换术后感染影响的比较[J].中国矫形外科杂志,2016,24(5):411-415.