杨波;王腾云;吴长坤;缪伟;姜鑫;

• 1:潍坊市人民医院关节外科
• 2:潍坊医学院临床医学院
• 3:潍坊市人民医院超声科

摘要(Abstract)：

[目的]评价经彩超诊断的下肢动脉粥样硬化对全膝关节置换术(TKA)早期结果的影响。[方法]回顾分析2017年1月-10月收治并符合纳入标准的353例(387膝) TKA患者,按照术前下肢动脉彩超诊断结果分为正常组151膝和病变组236膝,病变组下肢动脉彩超诊断动脉粥样硬化。所有病例在半程止血带下行TKA。术后比较两组切口并发症、VTE发病率。[结果]病变组的年龄显著高于正常组,两组比较差异有统计学意义(P<0.05),提示年龄增加血管病变的发生也增加。两组中性别构成差异有统计学意义(P<0.05),提示男性患者下肢动脉粥样硬化发病率较女性高。两组间并存高血压病、高脂血症、糖尿病和冠状动脉粥样硬化性心脏病的差异无统计学意义(P>0.05)。术后早期两组切口并发症、VTE发病率差异均无统计学意义(P>0.05)。但合并糖尿病患者术后切口并发症发病率更高(P<0.05)。[结论]经彩超诊断的下肢动脉粥样硬化患者行TKA术是安全的,未增加术后切口并发症、VTE风险。糖尿病是术后切口并发症的独立风险因素。

关键词(KeyWords)： 下肢动脉粥样硬化;全膝关节置换术;切口并发症;静脉血栓栓塞

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 杨波;王腾云;吴长坤;缪伟;姜鑫;

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参考文献(References)：

• [1]Steven M,Koehler MD,Adam Fields BA,et al.Safety of tourniquet use in total knee arthroplasty in patients with radiographic evidence of vascular calcifications[J].Am J Orthop(Belle Mead NJ)2015,44(9):E308-316.
• [2]Verena J,Woelfle-Roos A,Dautel L,et al.Vascular calcifications on the preoperative radiograph:harbinger of tourniquet failure in patients undergoing total knee arthroplasty[J].Skeletal Radiol2017,46(9):1219-1224.
• [3]Walls RJ,O'Malley J,O'Flanagan SJ,et al.Total knee replacement under tourniquet control:a prospective study of the peripheral arterial vasculature using colour-assisted duplex ultrasonography[J].Surgeon,2015,13(6):303-307.
• [4]Garabekyan T,Oliashirazi A,Winters K.The value of immediate preoperative vascular examination in an at-risk patient for total knee arthroplasty[J].Orthopedics,2011,34(1):52.
• [5]Abu Dakka M,Badri H,Al-Khaffaf H.Total knee arthroplasty in patients with peripheral vascular disease[J].Surgeon,2009,7(6):362-365.
• [6]De Laurentis DA,Levitsky KA,Booth RE,et al.Arterial and ischemic aspects of total knee arthroplasty[J].Am J Surg,1992,164(3):237-240.
• [7]Smith TO,King JJ,Hing CB.A meta-analysis of randomised controlled trials comparing the clinical and radiological outcomes following minimally invasive to conventional exposure for total knee arthroplasty[J].Knee,2012,19(1):1-7.
• [8]Rama KR,Apsingi S,Poovali S,et al.Timing of tourniquet release in knee arthroplasty.Meta-analysis of randomized,controlled trials[J].J Bone Joint Surg Am,2007,89(4):699-705.
• [9]Tai TW,Lin CJ,Jou IM,et al.Tourniquet use in total knee arthroplasty:a meta-analysis[J].Knee Surg Sports Traumatol Arthrosc,2011,19(7):1121-1130.
• [10]Yi S,Tan J,Chen C,et al.The use of pneumatic tourniquet in total knee arthroplasty:a meta-analysis[J].Arch Orthop Trauma Surg,2014,134(10):1469-1476.
• [11]Langkamer VG.Local vascular complications after knee replacement:a review with illustrative case reports[J].Knee,2001,8(4):259-264.
• [12]Smith DE,Mc Graw RW,Taylor DC,et al.Arterial complications and total knee arthroplasty[J].Am Orthop Surg,2001,9(4):253-257.
• [13]Butt U,Samuel R,Sahu A,et al.Arterial injury in total knee arthroplasty[J].Arthroplasty,2010,25(8):1311-1318.
• [14]Callam MJ,Harper DR,Dale JJ,et al.Arterial disease in chronic leg ulceration:an underestimated hazard?Lothian and Forth Valley Leg Ulcer Study[J].Br Med J(Clin Res Ed)1987,294(6577):929-931.
• [15]Tie K,Hu D,Qi Y,et al.Effects of tourniquet release on total knee arthroplasty[J].Orthop,2016,39(4):642-650.
• [16]Hussein AA,Uno K,Wolski K,et al.Peripheral arterial disease and progression of coronary atherosclerosis[J].Am Coll Cardiol,2011,57(10):1220-1225.
• [17]Malinzak RA,Ritter MA,Berend ME,et al.Morbidly obese,diabetic,younger,and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates[J].Arthroplasty,2009,24(6 Suppl):84-88.
• [18]Vince K,Chivas D,Droll KP.Wound complications after total knee arthroplasty[J].Arthroplasty,2007,22(4 Suppl 1):39-44.
• [19]Ahmed AA,Mooar PA,Kleiner M,et al.Hypertensive patients show delayed wound healing following total hip arthroplasty[J].PLo S One,2011,6(8):23224.(:2018-04-11)