膝关节置换手术后短期内并发症与翻修状况分析

摘要

目的 探讨膝关节置换手术后短期内并发症、并发症原因与翻修状况.方法 选取2010年1月至2015年11月于该院进行人工全膝关节置换术的患者440例522膝,均采用标准膝前正中切口髌旁内侧入路行人工全膝关节置换术,均实施固定平台的膝关节置换,通过骨水泥进行假体固定,分析膝关节置换手术后短期内并发症、并发症原因与翻修状况.结果 伤口并发症发生率为8.2%,包括无菌性渗出12例14膝,浅表感染10例14膝,皮缘坏死6例7膝,皮下血肿4例4膝,脂肪液化2例2膝,2例2膝发生关节红肿并深部感染.类风湿性关节炎患者发生伤口并发症的发生率显著高于其他类型病因患者,差异有统计学意义(P<0.05);畸形矫正程度≥20°的患者发生伤口并发症的发生率显著高于小于15°、大于或等于15°且小于20°的患者,差异有统计学意义(P<0.05);伴有伤口并发症患者的止血带平均使用时间为(88.3±13.7)min,显著高于无伤口并发症患者的止血带平均使用时间(78.1±9.5)min,差异有统计学意义(P<0.05);48膝未进行伤口引流的并发症发生率为20.8%,显著高于伤口引流患者的7.0%,差异有统计学意义(P<0.05).共有18膝接受翻修手术,翻修率3.4%(18/522),翻修的原因有深部感染引发的假体松动、关节僵硬、无菌松动、聚乙烯垫片磨损与关节不稳、假体周围骨折,分别占1.3%、0.8%、0.6%、0.6%、0.4%.结论 人工全膝关节置换术后短期内易发生伤口并发症,降低止血带使用时间、实施伤口引流可以减少并发症的发生,翻修的最常见原因为深部感染引发的假体松动,临床上应积极预防.%Objective To investigate the short-term complications and revision status after knee replacement surgery.Methods A total of 440 patients(522 knees) undergoing total knee arthroplasty in the hospital were standard knee from January 2010 to November 2015 performed the operation by adopting standard median incision via patellar medial approach,implemented the knee joint replacement with fixed platforms and conducted the prosthesis fixation by bone cement.The short term complications after knee replacement surgery,causes and revision status were analyzed.Results The wound complications incidence rate was 8.2%,including aseptic exudation in 12 cases(14 knees),superficial infection in 10 cases(14 knees),skin edge necrosis in 6 cases(7 knees),subcutaneous hematoma in 4 cases(4 knees),fat liquefaction in 2 cases(2 knees) and knee joint swelling and deep infection in 2 cases(2 knees).The incidence rate of wound complications in the patients with rheumatoid arthritis was significantly higher than that in the patients with other types of causes(P>0.05);the incidence rate of wound complications in the patients with DDC≥20° was significantly higher than that in the patients with DDC<15°and the patients with 15°≤DDC<20°,the difference was statistically significant(P<0.05);the tourniquet use time in the patients with wound complications was(88.3±13.7)min,which significantly higher than(78.1±9.5) min,the difference was statistically significant(P<0.05);the incidence rate of wound complications in 48 knees without wound drainage was 20.8%,which was significantly higher than 7% in the patients with wound drainage,the difference was statistically significant(P<0.05).A total of 18 knees underwent revision surgery with the revision rate of 3.4%(18/522),the reasons for revision had the prosthesis loosening,joint stiffness,aseptic loosening,polyethylene wear and joint instability,periprosthetic fractures,accounting for 1.3%,0.8%,0.6%,0.6% and 0.4% respectively.Conclusion The wound complications are easier to occur within the short term after total knee arthroplasty.Reducing the tourniquet use time and implementing wound drainage can reduce the occurrence of complications.The most common reason is the prosthesis loosening caused by deep infection,which should be actively prevented in clinic.