止血带在全膝关节置换术中不同应用方式的比较研究

Comparison of effect of tourniquet in different periods of total knee arthroplasty

摘要:

分析对比止血带应用于不同时期全膝关节置换术（TKA）的疗效差异。方法随机选取于2015 年6 月-2016 年12 月于该院接受全膝关节置换术治疗的患者共计78 例，根据术中应用止血带方式的不同将患者随机分为3 组：A 组（术中接受全程止血带治疗），B 组（仅于假体安装时应用止血带治疗，于膝关节假体成功放置且骨水泥硬化时结束，即限制性使用止血带），C 组（于截骨后开始应用止血带，加压包扎后停止使用），每组各26 例。比较3 组患者止血效果以及术后膝关节功能恢复情况，评估TKA 术中不同时期给予止血 带治疗的效果差异。结果3 组患者手术时间、围手术期失血量及输血例数比较，差异无统计学意义（p >0.05），与A、C 组比较，B 组隐性失血较少，术后并发症发病率低，住院时间减少，膝关节功能恢复相关评分以及软组织损伤指标改善显著（p <0.05）。结论限制性使用止血带能够有助于降低患者隐形出血量，同时减少患者肢体肿胀，有助于患者术后膝关节功能恢复并减少术后并发症的发生，为全膝关节置换术后患者膝关节早期功能恢复提供有力支持，值得临床推广应用。

Abstract:

To compare the application effect of tourniquet in different periods of total knee arthroplasty. Methods Totally 78 cases undergoing total knee arthroplasty from June 2015 to December 2016 were randomly selected and divided into groups A, B and C. Tourniquet was used in the 3 different periods of the operation in the 3 groups respectively. In the group A tourniquet was used during the whole process of operation. In the group B, the use of tourniquet was restricted to the time from the start of prosthesis installation to the successful placement of the knee prosthesis and the hardening of cement. In the group C, tourniquet usage was started just after osteotomy, and ended after pressure bandaging. The effect of arthroplasty was compared among the 3 groups and the indexes of recovery were analyzed. Results After SPSS 10.0 analysis, the 3 groups had no significant difference in the operation time, the amount of perioperative bleeding or the case number of blood transfusion (p > 0.05), while the group B had a lower amount of invisible bleeding, a lower rate of postoperative complications and shorter time of hospital stay (p < 0.05), which led to better HSS and ROM scores and indexes of soft tissue injury ( p< 0.05).Conclusions Using tourniquet only during the procedure of implanting prosthesis can significantly reduce the amount of invisible bleeding and the incidences of postoperative complications, and relieve the tissue swelling, which can be helpful to the recovery.