全膝关节表面置换术中不同时期使用电动止血带的临床效果比较  

Comparison study of clinical effect of electric tourniquet in total knee replacement used in different periods

作　　者：杨晨[1] 游建军[1] 王利[2] 袁宏[2] 

机构地区：[1]新疆阿克苏地区第一人民医院骨科,新疆阿克苏843000 [2]新疆维吾尔自治区人民医院骨科,新疆乌鲁木齐830000

出　　处：《中国现代医学杂志》2014年第8期71-77,共7页China Journal of Modern Medicine

基　　金：新疆医科大学临床医学院科研奖励基金资助项目(No:2011-QYY-12)

摘　　要：目的分析止血带对膝关节置换术（TKA）围手术期失血量和深静脉血栓（DVT）发生率以及膝关节活动度的影响。方法选取2009年1月~2012年1月240例在该院初次单侧膝关节置换术患者,入院后随机分为4组：试验组A采用电动止血带术前驱血加压,手术伤口关闭加压包扎后再放松止血带的＂全程止血带技术;试验组B仅在用骨水泥黏合假体前驱血电动止血带术加压,假体安装完毕骨水泥完全凝固后即放松止血带的＂中途止血带技术＂;试验组C采用电动止血带术前开始驱血加压,假体安装完毕骨水泥完全凝固后即放松止血带行切口内彻底止血后关闭手术伤口的＂半全程止血带技术＂;对照组D则完全不使用电动止血带。比较4组患者平均手术时间与止血带使用时间、术中失血量与术后失血量、术后隐性失血量、下肢DVT发生率、术前及术后早期的KSS评分、膝关节早期活动度（ROM）指标。结果 4组比较后试验组患者的止血带时间、术中失血、,术后失血、总失血量、术后并发深静脉栓塞例数均较对照组明显减少,以试验组C的效果最佳。结论膝关节置换术在安装假体、骨水泥固化后再释放止血带的半全程止血带技术,创面止血能够减少围手术期失血量,DVT的发生率未增加,同时对膝关节活动度的影响小,值得推广。[Objective] To analyze the incidence and effect of knee joint activities of tourniquet for knee arthroplasty （TKA） perioperative blood loss and deep vein thrombosis （DVT）. [Methods] January 2009 to January 2012, 240 cases initial single side knee replacement operation patients, randomly divided into four group： ramped 1： use electric bleeding with operation Qian began drive blood pressurized, surgery wound close pressurized dressing again relax bleeding with of full bleeding with technology, ramped 2 only with bone cement bonding fake body precursor blood electric bleeding with operation pressurized, fake body installed finished bone cement full solidification that relax bleeding with of midway bleeding with technology, pilot group 3 with electric blood pressure tourniquet before operation start flooding, bone cement prosthesis is installed fully freezing loosen tourniquet once the incision closed surgical wounds after total hemostasis within half full tourniquet technique. Control groups are not made using electric tourniquets. Compare four groups of average operative time and tourniquet use in time, blood loss during surgery and post-operative blood loss and postoperative occult blood loss, lower extremity DVT incidence of KSS, preoperative and postoperative early scoring, the knee earlier activity （ROM） indicators. [Results] After tourniquet time, intra-operative blood loss, post-operative blood loss and total blood volume, number of cases of deep vein thrombosis after surgery were higher than those in the control group declined significantly. Best in Group 3. [Conclusion] In TKA installed prostheses, bone cement, then half-full release tourniquet technology, wound bleeding to reduce perioperative blood loss, did not increase the incidence of DVT, and impact on activity of knee, merits promotion.

关 键 词：关节成形术 置换 膝关节 止血带 

分 类 号：R687.4[医药卫生—骨科学]