人工全膝关节置换术中保留滑膜对术后感染的预防效果

目的 探析人工全膝关节置换术(TKA)中保留滑膜对术后感染的预防效果,进一步明确其可行性和临床效果.方法 回顾性分析2014 年1 月—2016 年1 月248 例行单膝TKA 原发性膝骨关节炎患者的临床资料,均行TKA 治疗,对照组120 例术中切除滑膜,观察组128 例术中保留滑膜,对比两组患者一般手术情况、感染指标水平变化情况、膝关节功能恢复及感染情况.结果 对照组患者手术时间(89.56 ±26.35) min、术中出血量(472.42 ±86.18) mL、术后24 h 引流量(685.25 ±92.68)mL 及术后输血率29.17%均明显高于观察组(71.25 ±21.58) min、(198.56 ±48.52) mL、(354.26 ±75.28) mL、10.94%](均P <0.05),两组患者在术后1 周关节活动范围、住院时间基本相近(均P >0.05);两组患者各项指标术后1 d、术后7 d 均较术前明显增高,于术后14 d 降至正常水平.观察组患者WBC、CRP、血沉水平在术前、术后1、7、14 d、术后6、12 周、术后6月、术后1 年8 个不同时间段均稍高于对照组,但经组间t 检验均P >0.05;观察组术后12 周HSS 评分表中功能评分(19.65 ±2.46) 分和总评分(86.06 ±1.68) 分均高于对照组(18.92 ±2.36)、(85.06 ±1.58) 分](均P <0.05),其他项评分两组评分基本相近(均P >0.05);术后1 年HSS 评分表中各项评分和总评分基本相近(均P >0.05);观察组患者术后感染率为0.78%明显低于对照组的5.00%(P <0.05).结论 人工全膝关节置换术中保留滑膜可缩短手术时间、减少出血量和输血量进而预防术后感染的发生,且不影响患者术后膝关节功能恢复,可在TKA 手术中广泛开展.

Prevention of postoperative infection with retained synovial membrane in total knee arthroplasty

Objective To explore the preventive effect of retained synovial membrane on postoperative infection in total knee arthroplas -ty(TKA),and further clarify its feasibility and clinical effect.Methods A retrospective analysis was made of clinical data of 248 ca-ses of single knee TKA primary knee osteoarthritis patients,who were treated with TKA from January 2014 to January 2016,120 cases in the control group with synovectomy,and 128 patients in the observation group with preservation of synovial membrane.Comparison was conducted of general surgery,infection index changes,recovery of knee joint function and infection between the two groups.Results The operation time(89.56 ±26.35)min],intraoperative blood loss(472.42 ±86.18)mL],postoperative 24 h drainage volume (685.25 ±92.68)mL]and postoperative blood transfusion rate(29.17%)in the control group were significantly higher than those in the observation group(71.25 ±21.58)min,(198.56 ±48.52)mL,(354.26 ±75.28)mL,10.94%](all P<0.05);One week after surgery,the two groups of had similar scope of joint activity and hospitalization time(all P>0.05).Each index of the two groups of patients 1 d,7 d after operation was significantly higher than that preoperatively,and decreased to normal level on the 14th day after surgery.The observation group of patients′WBC,CRP,ESR levels at 8 different time points,including preoperatively,1,7,14 d,6-week,12-week,6-month and 1-year postoperatively,were slightly higher compared with the control group,but the t test between groups showed that P>0.05.The functional score(19.65 ±2.46)points]and total score(86.06 ±1.68)points]in the 12-week HSS scoring table were higher than those in the control group(18.92 ±2.36)points,(85.06 ±1.58)points](all P<0.05),while oth-er scores of the two groups were similar(P>0.05).The scores and total score of the 1 year postoperative HSS score were approximate-ly similar(all P>0.05).The postoperative infection rate of the observation group(0.78%)was significantly higher than 5.00%of the control group(P<0.05).Conclusions Synovial retention in total knee arthroplasty can shorten the operation time,prevent post-operative blood loss and transfusion to reduce the incidence of infection,and doesnot affect the postoperative recovery of knee joint func-tion after surgery,which can be widely carried out in TKA.