Correlation Study Of Pulmonary Embolism During Total Knee Arthroplasty

ObjectiveTo research the composition and the influence on the body of fat embolus derived from bone marrow of free fat tissue after releasing the tourniquet during TKA surgery,and though comparing the value of reducing embolus the right atrial between the modified negative pressure aspirator and computer navigation technology during TKA surgery as experimental group,looking for cheap,easy to promote fat embolism prevention measures.MethodIt is a prospective study that setting 40 cases of osteoarthritis patients undergoing unilateral TKA for the first time during June 2014 to June 2015 as the research object,using transesophageal echocardiography(TEE)to records the variation of embolus in right atrium and pulmonary artery pressure before and after releasing tourniquet,obtaining right atrium blood though central venous catheter during the operation to make pathological analysis,make anther a prospective study that setting 40 cases of osteoarthritis patients undergoing unilateral TKA for the first time during June 2014 to June 2015 as the control group,taking conventional total knee arthroplasty during operation;setting 40 cases of osteoarthritis patients undergoing bilateral TKA for the first time during march 2014 to June 2015,applying computer aided navigation technology for the left keen and using conventional surgery for the right knee,adding modified negative pressure aspirator for the right knee,using transesophag ealechocardio graphy(TEE)to records of right atrium embolus and pulmonary artery pressure changes before and after releasing tourniquet amount,the evaluation indicator is the relative area of embolus and variation of pulmonary artery pressure.ResultAtrial embolus was observed after releasing tourniquet and pulmonary artery pressure rises 25 to 40 percent and return to normal within 1 to 3 minutes.We also found fat and a small amount of primitive cells in right atrium blood,with 25 cases of fat positive in 40 cases,8 cases of weakly positive original cells in blood sample though immunohistochemical,there is no statistical significance of the blood oxygen saturation(SpO2)and oxygen partial pressure(PaO2)and mean arterial pressure(MAP)during operation.Embolus quantity and variation of pulmonary artery pressure in the experimental group is lower than the conventional group(P< 0.05),with statistical significance;the embolus quantity and variation of pulmonary artery pressure between computer navigation group and modified negative pressure aspirator group has no statistical difference(P>0.05).ConclusionThe conventional total knee replacement technology within the bone marrow locating rod can lead to bone marrow fat tissue into the pulmonary circulation,the embolus flowing into the pulmonary vascular bed it could hamper the blood flowing of pulmonary vascular bed,increasing the pulmonary artery pressure,this may cause pulmonary embolism symptoms during the operation of TKA,this phenomenon is more obvious in patients with obesity and older.The modified negative pressure aspirator can effectively reduce embolus into the right atrium after releasing the tourniquet,but the cost is much lower than computer aided navigation,witch can be further promote in clinic.