全髋关节表面置换术与传统全髋关节置换术围手术期总失血量的比较研究

目的比较全髋表面置换术（HRA）和传统全髋置换术（THA）围手术期的总失血量以及术后住院时间,探讨两种术式不同的失血机制及其对手术创伤的影响。方法 2009年1月至2009年12月,选择67例髋关节骨病患者,分为两组分别施行HRA和THA,HRA组34例（34髋）,THA组33例（33髋）THA,两组均为初次单侧关节置换。通过Gross方程,根据身高、体重和手术前后的红细胞压积（Hct）变化差值算出所有患者的总失血量,记录显性失血量（术中出血和术后引流量）,推算出隐性失血量。记录手术时间和术后住院时间,将以上数据进行比较。结果 HRA组总失血量、显性失血量和隐性失血量都与THA组有统计学差异。总失血量HRA组和THA组分别为（1048.0±134.2）ml和（1466.0±167.4）ml,两组间差异有统计学意义（t=11.3,P〈0.05）;术中出血量分别为（542.0±68.9）ml和（625.0±86.3）ml,两组间差异有统计学意义（t=4.4,P〈0.05）;术后引流量分别为（266.0±93.9）ml和（379.0±162.7）ml,两组间差异有统计学意义（t=3.5,P〈0.05）;平均隐性失血量分别为（240.0±43.4）ml和（462.0±71.5）ml,两组间差异有统计学意义（t=15.3,P〈0.05）;平均术后住院时间HRA组也明显缩短,HRA为（4.6±0.9）d,THA为（6.1±0.9）d,两组间差异有统计学意义（t=7.0,P〈0.05）;平均手术时间HRA组则比HA组延长,HRA组为（114±13.9）min,THA组为（87±18.5）min,两组间差异有统计学意义（t=-6.9,P〈0.01）。结论尽管HRA比THA手术时间和手术切口都有延长,但总出血量明显降低,尤其是隐形失血量,术后住院时间也缩短,说明HRA出血相对偏少,创伤相对较小。

Total blood loss in total hip resurfacing arthroplasty and conventional total hip arthroplasty: a comparative study

Objective To evaluate the blood loss in total hip resurfacing arthroplasty （HRA） comparing with conventional total hip arthroplasty （THA）. Methods From January, 2009 to December, 2009, 34 patients were performed total hip resurfaeing arthroplasty （HRA group） and 33 patients were performed eonvetional total hip arthroplasty （THA group）. All the operations were conducted by the same surgeon. HRA group involved 20 males and 14 females with an average age of 48.7 years （range, 21 -65 years）. THA group involved 16 males and 17 females with an average age of 57.4 years （range, 39 -65 years）. All arthroplasties were primary and unilateral. Total perioperative blood loss included perioperative visible blood loss and hidden blood loss. Using Gross formula, the total blood loss was calculated according to height, weight and pre-and postoperation hematocrit （HCT） , while the hidden hemorrhage volume was calculated by subtracting the visible blood loss from total loss. Total perioperative blood loss, visible blood loss, hidden blood loss, length of incision, duration of operation and length of hospital-stay were measured and compared. Results In HRA group, there were less total estimated blood loss [ average （ 1048.0 ± 134. 2） ml of HRA group versus （ 1466. 0 ± 167.4） ml of THA group; P 〈 0. 01 ] , less intraoperative blood loss [average （542.0 ±68.9） ml of HRA group versus （625.0 ± 86.3） ml of THA group; P 〈0. 01 ] and much less hidden blood loss average （240. 0 ± 43.4） ml of of HRA group versus （ 462.0 ± 71.5 ） ml of of THA group ; P 〈 0.05 ]. There was shorter duration of hospital stay in HRA group （4. 6 ± 0. 9 ） days of HRA group versus （6.1 ± 0. 9） days of THA group, P 〈 0. 05 ）, and longer operation time in HRA group [ （ 114 ± 13.9 ） rain versus （ 87 ±18. 5 ） rain ]. Conclusions Total hip resurfaeing arthroingastv Rave rise to a positive final imnression with regard to reallv less bleedin and less injury.