止血带对全膝关节置换术中股骨远端旋转定位时髌骨轨迹的影响

Objective To explore, the influence of tourniquet application on patellar tracking with using the surgical transepieondylar axis as distal femur alignment in total knee arthroplasty (TKA). Methods From December 2002 to August 2008, 349 cases (526 knees) of primary TKA were performed. There were 124 males and 225 females with an average age of 68 years from 33 to 84 years. A total of 387 knees had varus deformity and 94 had valgus deformity. All of prosthesis were rotating platform with posterior cruciate ligament retaining provided by Gemini MK Ⅱ. All patients underwent anterior medial parapatellar approach. The surgical transepieondylar axis had been principally used as the distal femur alignment. Patellar tracking was checked with no thumb test. For maltracking ones, we prefered to use a single retinacular closing stitch at the superior medial arthrotomy and deflate tourniquets. Patellar tracking was checked again. Finally, later-al retinaeular releases (LRR) had been performed to obtain optimizing patellar tracking. Results Intraoper-atively, no thumb test were positive in 138 knees, including patellar subluxation (vaigus deformity) in 12 knees and patellar inclining (74 of valgns deformity and 52 of varus deformity) in 126 knees. After using a single retinacular closing stitch at the superior medial arthrotomy and deflating tourniquets, no thumb test were positive in 40 knees, including patellar subluxation (valgus deformity) in 8 knees and patellar inclining (29 of valgns deformity) in 32 knees. The total rate of LRR was 7.6% (40/526), the rate of LRR in valgus deformity was 39.4% (37/94) and that in yarns deformity and no deformity was 0.7% (3/432). Conclusion There was significant influence of tourniquet application on patellar tracking during the TKA. We were not falsely correcting patellar tracking problems with using a single retinaeular closing stitch at the superior me-dial arthrotomy anti deflating tourniquets intraoperatively and reducing the rate of LRR.     

双止血带结扎法顺行性下肢静脉造影影像分析

对６８例下肢静脉曲线患者行顺行性下肢静脉造影，其中采用双止血带结扎法和单止血带结扎法造影各３０例，另８例为术后复发病例，分别采用二种方法造影通过对比分析采用二种方法在使用同等造影剂量与限度的情况下，各自对下肢静脉显影的影像分析，认粗要用双在带结扎造影法对下肢深静脉显影的质量及病因诊断率明显优于传统单止血带结扎造影法。     

异丙酚对松止血带诱导的缺血/再灌注损伤的影响

骨科四肢手术常使用止血带,在给手术带来方便的同时,可引起局部组织的缺血[1]。而在松止血带时可造成缺血组织的再灌注损伤,氧自由基在这种损伤中起重要作用。文献报道,异丙酚具有明显的抗氧化作用[2],保护机体,维持机体内环境的稳定。本文通过术中静注异丙酚测定血中MDA及NO的变化,观察异丙酚对松止血带诱导的缺血/再灌注损     

无菌弹力绷带在膝关节镜手术中的应用

膝关节手术通常需在下肢缠无菌绷带以保护术野，手术中由于患者双下肢持续下垂，用气动止血带因手术时间较长，患肢易发生红肿。鉴此，我科于2005年6～12月对50例膝关节镜手术患者采用无菌弹力绷带替代，增加患者舒适度，护理报告如下。[第一段]     

全膝关节置换术中止血带应用的研究进展

全膝关节置换术(TKA)是治疗重度骨关节退行性疾病、重建膝关节功能的重要手段,使用止血带是手术过程中的常规操作。一般认为,使用止血带能减少膝关节置换术中出血,更加清晰的暴露术野,减少神经及血管等医源性损伤。但由于止血带本身的一些特性,使用止血带可能带来神经压迫损伤、血管内皮细胞的缺血再灌注损伤以及全身血流动力学的改变等。近年来,对于TKA术中使用止血带的应用研究报道逐渐增多,本文对此做一综述。     

循证护理在预防电动止血带疼痛中的应用

目的减轻或避免术中止血带引起的疼痛。方法应用循证护理探讨止血带疼痛发生的相关因素,并采取合理的针对性的护理措施。结果 126例患者使用电动止血带后,术野清楚,术中配合良好,疼痛发生率降低。结论重视心理护理,科学合理使用电动止血带,能有效预防止血带引起的疼痛。     

缺血预处理在全膝关节置换术中的应用

目的观察缺血预处理对全膝关节置换术(TKA)肢体缺血再灌注损伤的影响。方法选择2011年1月—2013年12月在我院初次行单侧TKA的患者60例,随机分为对照组和缺血预处理组。缺血预处理措施为止血带持续充气加压前阻断术肢血流5 min,然后松止血带,恢复血流灌注5 min,反复2次。于肢体缺血前、再灌注24 h和72 h分别检测血清肌酸磷酸激酶(CK)、天冬氨酸氨基转移酶(AST)和乳酸脱氢酶(LDH)的含量。结果肢体缺血再灌注后各时间点与缺血前比较,血清CK、AsT、LDH含量均明显增高(P<0.05),但缺血预处理组明显低于对照组,两组比较,差异有统计学意义(P<0.05)。结论缺血预处理可以减低肢体缺血再灌注损伤。     

止血带使用时机选择对失血量及患肢再灌注损伤的影响

目的:分析止血带使用时机选择对失血量及患肢再灌注损伤的影响,为减少骨科手术的再灌注损伤提供主要依据。方法:随机选取2011年4月-2013年12月经我院骨科诊断并进行手术的四肢骨折患者86例作为分析对象,分为对照组A和对照组B,各43例。对照组A应用传统的方法,在术前止血带技术条件下,手术开始前即使用止血带。对照组B在术中止血带技术条件下,手术切开浅表组织并止血后使用止血带。分别记录两组患者手术造成总失血量、血浆丙二醛浓度及术后康复情况,并比较。结果:对照组B总失血量略高于对照组A,血浆丙二醛浓度及术后康复比率均优于对照组A。P均<0.05,均具有统计学意义。结论:术前止血带技术和术中止血带技术在失血量、再灌注损伤及预后方面各有优势,可以根据手术特点选用合适止血带技术。