Claus A, Asche G, Brade J, Bosing-Schwenkglenks M, Horchler H, Müller-Färber J, Schumm W, Weise K, Scharf H-P
Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum, Mannheim.
Unfallchirurg. 2006 Jan;109(1):5-12. doi: 10.1007/s00113-005-0992-2.
Postoperative complications following primary total knee replacement performed between 2000 and 2002 were assessed to determine perioperative patient- and procedure-related risks associated with the procedure.
For this analysis, the data collected during postoperative hospitalization for 17,644 total knee arthroplasties were assessed. The analysis included two steps. First, using logistic regression, we identified and quantified significant risk factors for the occurrence of general postoperative complications. Second, univariate analysis was utilized to qualitatively and quantitatively analyze the influence of these significant risk factors on the occurrence of major complications (hematoma, cardiovascular complication, deep venous thrombosis, pulmonary embolism, joint infection, and pneumonia).
General postoperative complications were reported in 11.3%. Major postoperative complications occurred in 7.2% with hematoma in 2.9%, cardiovascular complications in 1.8%, deep venous thrombosis in 1.2%, pulmonary embolism in 0.2%, joint infection in 0.8%, and pneumonia in 0.3%. Patient-related risk factors such as age, surgery time, gender, high ASA classification as well as procedure-related risk factors such as allogeneic blood transfusions and lateral release significantly increased the rate of postoperative complications. Males were more prone to hematoma, joint infection, and pneumonia in the immediate postoperative course than females, who were more in danger of developing deep venous thrombosis. Allogeneic blood transfusions increased the risk for postoperative hematoma, infection, and cardiovascular complication. Regional anesthesia was shown to decrease the risk for the occurrence of postoperative deep venous thrombosis and pulmonary embolism.
Postoperative complications in total knee replacement are increased in males and elder patients. Increased time of surgery and allogeneic blood transfusions also represent important risk factors for postoperative complications following primary total knee replacement.
评估2000年至2002年间进行的初次全膝关节置换术后的并发症，以确定与该手术相关的围手术期患者及手术相关风险。
对于此次分析，评估了17644例全膝关节置换术术后住院期间收集的数据。该分析包括两个步骤。首先，使用逻辑回归，我们确定并量化了术后一般并发症发生的显著风险因素。其次，采用单因素分析定性和定量分析这些显著风险因素对主要并发症（血肿、心血管并发症、深静脉血栓形成、肺栓塞、关节感染和肺炎）发生的影响。
报告的术后一般并发症发生率为11.3%。术后主要并发症发生率为7.2%，其中血肿发生率为2.9%，心血管并发症发生率为1.8%，深静脉血栓形成发生率为1.2%，肺栓塞发生率为0.2%，关节感染发生率为0.8%，肺炎发生率为0.3%。与患者相关的风险因素，如年龄、手术时间、性别、高ASA分级以及与手术相关的风险因素，如异体输血和外侧松解，均显著增加了术后并发症的发生率。男性在术后即刻比女性更容易发生血肿、关节感染和肺炎，而女性发生深静脉血栓形成的风险更高。异体输血增加了术后血肿、感染和心血管并发症的风险。区域麻醉显示可降低术后深静脉血栓形成和肺栓塞的发生风险。
全膝关节置换术后男性和老年患者的并发症增加。手术时间延长和异体输血也是初次全膝关节置换术后并发症的重要风险因素。
