在进行髋臼手术之前先处理股骨，并不会减少初次全髋关节置换术中的总失血量。
Preparing the femur before the acetabulum does not reduce total blood loss in primary total hip replacement.
作者信息
Stevens Jarrad M, Shiels Sarah, Whitehouse Michael, Baker Richard
机构信息
Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.
Knox Orthopaedic Group, Melbourne, Australia.
出版信息
J Orthop. 2019 Apr 7;16(4):353-355. doi: 10.1016/j.jor.2019.03.023. eCollection 2019 Jul-Aug.
INTRODUCTION
Total hip replacement is a common and effective surgical intervention for patients with debilitating joint pain but it does represent a significant surgical intervention. For such interventions, blood loss is a potential cause of morbidity and mortality. Optimisation of surgical interventions focuses on reducing such risks. The aim of this study was to determine whether the order of surgical steps, preparing the femur before or after the acetabulum, was associated with the amount of total blood loss in total hip replacement.
METHODS
We performed a retrospective study of 100 patients undergoing primary total hip replacement between 2014 and 2018. This was a before and after (interrupted time series) study around the introduction of femur first preparation for total hip replacement in our unit. Fifty patients underwent a standard femoral preparation after placement of the acetabular component. The second 50 patients had the femoral canal prepared and broached prior to the acetabular component. Estimated blood volume and total blood loss associated with the perioperative period were calculated for each patient and a multiple regression analysis performed to account for other patient and surgical variables associated with perioperative blood loss.
RESULTS
There was a small reduction in total blood loss for the group who underwent femoral preparation prior to acetabular preparation with a mean difference of 39 mls. This difference however was not clinically or statistically (p = 0.392) significant. Gender (p < 0.0001), Body Mass Index (BMI; p < 0.0001), preoperative haematocrit (p < 0.0001), postoperative haematocrit (p < 0.0001) and age (p = 0.004) were the only factors significantly associated with the total volume of blood loss.
CONCLUSIONS
Whether the femur was prepared before or after the acetabulum did not significantly predict the total volume of blood loss for primary total hip replacement.
引言
全髋关节置换术是治疗关节疼痛患者的一种常见且有效的手术干预措施，但它确实是一项重大的手术。对于此类手术，失血是发病和死亡的潜在原因。优化手术干预措施的重点是降低此类风险。本研究的目的是确定手术步骤的顺序，即先准备股骨还是先准备髋臼，是否与全髋关节置换术中的总失血量有关。
方法
我们对2014年至2018年间接受初次全髋关节置换术的100例患者进行了回顾性研究。这是一项围绕在我们科室引入先准备股骨的全髋关节置换术的前后（中断时间序列）研究。50例患者在髋臼假体植入后进行标准的股骨准备。另外50例患者在髋臼假体植入前对股骨髓腔进行准备和扩髓。计算每位患者围手术期的估计血容量和总失血量，并进行多元回归分析，以考虑与围手术期失血相关的其他患者和手术变量。
结果
先准备股骨再准备髋臼的组总失血量略有减少，平均差异为39毫升。然而，这种差异在临床或统计学上（p = 0.392）均无显著意义。性别（p < 0.0001）、体重指数（BMI；p < 0.0001）、术前血细胞比容（p < 0.0001）、术后血细胞比容（p < 0.0001）和年龄（p = 0.004）是与总失血量显著相关的唯一因素。
结论
先准备股骨还是先准备髋臼并不能显著预测初次全髋关节置换术的总失血量。
Zotero 插件