全髋关节置换术止血麻药激素混合液关节内灌注的作用△

Significance of intraarticular infusion of hemostaticanesthetic- steriod mixture in total hip arthroplasty

摘要:

[目的] 探讨全髋关节置换术（total hip arthroplasty, THA） 关节腔灌注止血麻药激素药物混合液的作用。[方法]回顾性分析 2022 年 10 月—2024 年 3 月初次单侧 THA 的 92 例患者的临床资料。依据术前医患沟通结果，46 例患者为药物组， THA 完成后给予关节内 120 mL 混合药物灌注；另外 46 例患者为对照组，关节内未使用药物。比较两组患者围手术期临床与检验资料。[结果]患者均顺利完成手术，无神经及血管损伤的并发症。两组在手术时间、切口长度、术中出血量和切口愈合等级的差异均无统计学意义 （P＞0.05）。但是，药物组的术后引流量 [(216.3±32.4) mL vs (387.4±45.9) mL, P＜0.001] 和总显性失血量 [(451.6±54.1) mL vs (625.5±63.3) mL, P＜0.001] 均显著低于对照组。此外，药物组术后 DVT 的发生率显著低于对照组 （2.2% vs 15.2%, P=0.026）。随术后时间推移，两组患者 VAS 评分均显著下降（P＜0.05），而 6 min 步行距离均显著增加（P＜0.05）。术后 1 d 和 2 d，药物组的 VAS 评分显著低于对照组 [(4.0±1.3) vs (6.7±1.4), P＜0.001; (4.1±1.2) vs (7.3±1.3), P＜0.001]。术后 3 d 和 7 d，药物组 6 min 步行距离均显著大于对照组 [(53.4±7.2) m vs (36.7±2.5) m, P＜0.001; (154.0±14.1) m vs (124.8±14.0) m, P＜0.001]。检验方面，术前两组 Hct 和 D-D 的差异均无统计学意义（P＞0.05）。与术前比较，术后 3 d 两组的 Hct 均显著降低（P＜0.05），而两组的 D-D 均显著升高 （P＜0.05）。术后 3 d，药物组的 Hct 显著高于对照组 [(38.1±1.3)% vs (36.2±0.5)%, P＜0.001]，而药物组的 D-D 显著低于对照组 [(325.8±42.9) μg/L vs (377.8±53.3) μg/L, P＜0.001]。[结论]关节腔灌注氨甲环酸联合罗哌卡因、地塞米松混合液能减轻 THA 术后疼痛，降低术后失血量，减少 DVT 的发生，有利于患肢功能恢复。

Abstract:

[Objective] To investigate the effect of intraarticular infusion of hemostatic-anesthetic-steriod mixture in total hip arthroplasty (THA). [Methods] A retrospective study was done on 92 patients who received the primary unilateral THA from October 2022 to March 2024. According to preoperative doctor-patient communication, 46 patients in the drug group had 120 mL of hemostatic-anestheticsteriod mixture infused intraarticularly after THA, while the other 46 patients in the control group had no drugs used with same volume of normal saline intraarticular infusion. The perioperative clinical and laboratory data of the two groups were compared. [Results] All patients had THA performed successfully without complications, such as nerve and vascular injuries. Although there were no significant differences in operation time, incision length, intraoperative blood loss and incision healing grade between the two groups (P＞0.05), the drug group proved significantly superior to the control group in terms of postoperative drainage volume [(216.3±32.4) mL vs (387.4±45.9) mL, P＜0.001] and total dominant blood loss [(451.6±54.1) mL vs (625.5±63.3) mL, P＜0.001]. In addition, the drug group had significantly lower incidence of postoperative deep venous thrombosis (DVT) than the control group (2.2% vs 15.2%, P=0.026). The pain VAS score was significantly decreased (P＜ 0.05), while the 6-minute walking distance was significantly increased in both groups over time postoperatively (P＜0.05). The drug group was significantly lower than the control group in VAS score [(4.0±1.3) vs (6.7±1.4), P＜0.001; (4.1±1.2) vs (7.3±1.3), P＜0.001] 1 and 2 days postoperatively, whereas the former was significantly higher than the latter in the 6-minute walking distance [(53.4±7.2) m vs (36.7±2.5) m, P＜0.001; (154.0±14.1) m vs (124.8±14.0) m, P＜0.001] 3 and 7 days after surgery. As for blood test, there was no significant difference in Hct and D-D between the two groups before operation (P＞0.05). Compared with those preoperatively, the Hct was significantly decreased (P＜ 0.05), while the D-D was significantly increased 3 days after surgery in both groups (P＜0.05). The drug group had significantly highe Hct than the control group [(38.1±1.3)% vs (36.2±0.5)%, P＜0.001], whereas the former measured significantly lower D-D than the latter [(325.8± 42.9) μg/L vs (377.8±53.3) μg/L, P＜0.001] 3 days postoperatively. [Conclusion] Intraarticular infusion of mixture, containing tranexamic acid, ropivacaine and dexamethasone, does reduce postoperative pain, decline postoperative blood loss, decrease occurrence of DVT, and is conducive to the functional recovery of the affected limb.after THA.