| 初次全膝关节置换后弹力绷带的应用 |
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| 引用本文： | 张成龙,胡川,张铭,郭祥琳,孙康. 初次全膝关节置换后弹力绷带的应用[J]. 中国组织工程研究, 2020, 24(24): 3851-3856. DOI: 10.3969/j.issn.2095-4344.2737 |
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| 作者姓名： | 张成龙 胡川 张铭 郭祥琳 孙康 |
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| 作者单位： | 青岛大学附属医院，骨科，肾病科，山东省青岛市 266000 |
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| 基金项目： | 青岛市民生科技计划项目(17-3-3-12-msh),项目负责人:孙康。 |
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| 摘 要： | 文题释义：全膝关节置换：是目前治疗晚期原发性骨关节炎或者类风湿性膝关节炎的有效手段。它主要是通过外科手术将膝关节假体置入患者体内，代替原本生理结构，从而达到消除疼痛、恢复力线以及改善功能的目的。弹力绷带：一般由自然纤维编织而成，治疗柔软，通常用于外科包扎护理。因其具有弹性高、透气性好、不会限制和影响活动、不会妨碍血液循环等独特优势，非常适合应用于关节部位的加压包扎。背景：全膝关节置换后常规使用弹力绷带到底会不会使患者受益，目前仍缺乏足够的临床证据。目的：探讨在初次全膝关节置换后使用弹力绑带是否对患者的预后有益。方法：选择2017年9月至2018年9月因膝关节骨关节炎在青岛大学附属医院西海岸院区关节外科接受初次同期双侧全膝关节置换的60例患者，随机选择一侧肢体使用普通外科敷料的同时使用从脚背到大腿中部的弹力绷带加压包扎(弹力绷带组)，一侧肢体只使用普通外科敷料(对照组)。所有患者对治疗方案均知情同意，且得到医院伦理委员会批准。由不参与患者管理的专业人员，在术后1，2，3和7 d分别测量患者双下肢(大腿、膝关节和小腿处)的周径、伸屈活动度以及静息、运动疼痛目测类比评分，记录术后24 h引流管引流量以及术后30 d内并发症发生情况。结果与结论：①术后第1，2，3，7天，弹力绷带组大腿、膝关节以及小腿周径均小于对照组，膝关节活动度优于对照组，差异有显著性意义(P < 0.001)；②术后第1，2天，弹力绷带组静息目测类比评分高于对照组(P < 0.001)，但是术后第7天低于对照组(P < 0.001)，在术后第3天，2组间差异无显著性意义；弹力绷带组运动目测类比评分在术后第1，2天要大于对照组(P < 0.001)，但在术后第3，7天时2组差异无显著性意义；③2组间在伤口愈合并发症方面没有差异，但样本量过小，无法用有意义的统计学方法进行分析；④2组间在术后24 h时引流管引流量差异比较有显著性意义；⑤随访30 d内均未出现深部感染、静脉血栓以及再手术情况；⑥提示在初次膝关节置换术后应用从脚背到大腿中部的弹力绷带能有效减轻术肢肿胀及术后失血量，增加术肢的屈伸活动，有利于术后快速康复，值得推广应用。ORCID: 0000-0001-6675-8904(张成龙)中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
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| 关 键 词： | 全膝关节置换 弹力绷带 膝关节功能 失血量 活动度 |
| 收稿时间： | 2019-12-10 |
Application of elastic compression bandage after first total knee arthroplasty |
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| Zhang Chenglong,Hu Chuan,Zhang Ming,Guo Xianglin,Sun Kang. Application of elastic compression bandage after first total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(24): 3851-3856. DOI: 10.3969/j.issn.2095-4344.2737 |
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| Authors: | Zhang Chenglong Hu Chuan Zhang Ming Guo Xianglin Sun Kang |
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| Affiliation: | Departmentof Orthopedics, Department of Nephrology, Affiliated Hospital ofQingdao University, Qingdao 266000, Shandong Province, China |
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| Abstract: | BACKGROUND:It is still lack of sufficient clinical evidence whether the patients can benefit from the routine use of elastic bandages after total knee arthroplasty.OBJECTIVE:To explore whether the use of elastic compression bandage after first total knee arthroplasty is beneficial to the prognosis of patients.METHODS:Totally 60 knee osteoarthritis patients who received bilateral knee arthroplasty in the Department of Joint Surgery,West Coast Hospital Branch of Affiliated Hospital of Qingdao University were selected from September 2017 to September 2018.One limb of the patient was covered with a general surgical dressing,while an elastic bandage was applied from the instep to the middle of the thigh(elastic compression bandage group).One limb was covered only with a general surgical dressing(control group).All patients signed the informed consent.The study was approved by the Hospital Ethics Committee.Circumference(thigh,knee and calf),flexural activity(range of motion)and visual analogue scale of the lower extremities were measured at 1,2,3 and 7 days after the operation by professionals who were not involved in patient management.Drainage volume 24 hours after operation and the occurrence of complications within 30 days after operation were recorded.RESULTS AND CONCLUSION:(1)At 1,2,3,and 7 days after surgery,circumference of thigh,knee and calf was smaller in the elastic compression bandage group than in the control group.Range of motion of the knee was better in the elastic compression bandage group than in the control group(P<0.001).(2)At 1 and 2 days after surgery,resting visual analogue scale scores were higher in the elastic compression bandage group than in the control group(P<0.001).At 7 days,resting visual analogue scale scores were lower in the elastic compression bandage group than in the control group(P<0.001).No significant difference in visual analogue scale scores was found between the two groups at 3 days.Sports visual analogue scale scores in the elastic compression bandage group were higher than in the control group at 1 and 2 days(P<0.001).However,no significant difference in sports visual analogue scale scores was detected between the two groups at 3 and 7 days.(3)There was no difference in wound-healing complications between the two groups,but the sample size was too small for meaningful statistical analysis.(4)There was a statistically significant difference in drainage volume between the two groups at 24 hours after surgery.(5)No deep infection,venous thrombosis or reoperation occurred within 30 days.(6)It is concluded that the application of elastic compression bandage from the instep to the middle of the thigh after the first total knee arthroplasty can effectively reduce the swelling of the operative limb and postoperative blood loss,increase the flexion and extension of the operative limb,which is conducive to the rapid recovery after the operation.It is worth popularizing and applying. |
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| Keywords: | total knee arthroplasty elastic compression bandage knee function bleeding volume range of motion |
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