【作者】 周建；

【导师】 何荣新；

【作者基本信息】 浙江大学 ， 外科学（专业学位）， 2014， 硕士

【摘要】 [目的]通过对人工膝关节置换术后感染病人与未感染病人的病例对照研究,研究可能影响患者膝关节置换术术后感染的危险因素。[方法]回顾性分析2010.1.1至2013.12.31出院的浙医二院行膝关节置换术的患者,以1720例未患膝关节置换术后感染的患者中系统抽样的87例为对照组,22例因确诊为膝关节置换术后感染的患者为病例组(其中13例患者于外院行膝关节置换术,9例于浙医二院行膝关节置换术)。两组患者年龄、性别、病史等一般统计资料上,并无显著的统计学差异(P>0.05),对试验研究过程中选择的病例的变量进行标准化控制,以减少变量对试验结果可能产生的误差：所有的病例手术过程均采用标准的关节置换流程；所有患者均为全麻下行膝关节置换术；术前常规使用抗生素静脉预防感染；所有患者均使用引流管；所有患者术后均抗凝治疗。通过对患者是否患有糖尿病,是否患类风湿性关节炎,是否有既往膝关节手术史,术中或术后是否有异体输血,手术时间,术中出血等因素进行对比,明确患者的危险因素。[结果]手术时间长(>80mIn,OR34.893,95%CI2.399-507.582, P=0.009),既往有膝关节手术史(OR9.522,95%CI2.025-44.786, P=0.004),患糖尿病(OR6.639,95%CI1.486-27.634, P=0.013)为膝关节置换术后感染的危险因素。[结论]应通过完善术前准备,加强手术管理,缩短手术时间,加强患者术后教育的方法,降低患者膝关节置换术后感染发生率。更多还原

【Abstract】 [Objectives]Through the comparison with noninfected cases and infected cases after total knee arthroplasty, research risk factors of infection In patients with total knee arthroplasty.[Methods]Retrospective analysis the patients who have total knee arthroplasty In The Second Affiliated Hospital of Zhejiang University Medical College between2010.1.1to2013.12.31, Systematic sampling87cases from1720cases without Infection after total knee arthroplasty as a control group,22cases diagnosed as Infection after total knee arthroplasty patients as case group(13cases had total knee arthroplasty done in other hospital,9cases done in The Second Affiliated Hospital of Zhejiang University Medical College). Two groups of patients with age, sex, medical history, the difference was not significant (P>0.05).The experimental study on the selection of rocess ariables were standardized control, to reduce the error variables may have on test results:joint replacement operation process flow cases all adopt the standard; all the patients were under general anesthesia; preoperative routine use of antibiotics to prevent infection; all patients were using drainage tube; all patients had the anticoagulant therapy. According to whether patients with diabetes, whether suffering from rheumatoid arthritis, whether there is a previous knee operation history, Intraoperative or postoperative whether allogeneic blood transfusion, operation time, ntraoperative bleeding and other factors were compared, make sure what the risk factors are.[Results]Long time operation (>80mIn, OR34.893,95%CI2.399-507.582, P=0.009), revious knee operation history (OR9.522,95%CI2.025-44.786,P=0.004), diabetes (OR6.639,95%CI1.486-27.634, P=0.013) are the risk factor of Infection after total Knee arthroplasty.[Conclusion]We should perfect preoperative preparation, strengthening operation management, shortening the time of operation, strengthen the education for patients, Infection rate was lower In patients after total Knee arthroplasty.更多还原