全膝关节置换术中止血带的应用方式比较  

Comparison for the strategies of tourniquet use in total knee arthroplasty

作　　者：昝鹏飞[1] 杨勇[1] 吴众[1] 杨庆波[1] 蔡郑东[1] 李国东[1] 

机构地区：[1]同济大学附属第十人民医院骨科-关节外科,上海200072

出　　处：《临床骨科杂志》2015年第6期693-696,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨全膝关节置换术(TKA)中止血带的不同应用方式对患者围手术期失血量、术后并发症、疼痛视觉模拟评分(VAS)以及膝关节功能恢复的影响。方法将211例TKA患者随机分为两组:A组105例,在切口关闭前释放止血带彻底止血;B组106例,在切口关闭弹力绷带加压包扎后释放止血带。比较两组围手术期总失血量、术后并发症、术后7 d及3个月的VAS、HSS评分以及实现膝关节90°屈曲的时间。结果总失血量:A组(945±368)ml,多于B组的(725±243)ml(P=0.032)。手术时间:A组(93.5±24.4)min,长于B组的(75.0±22.1)min(P<0.001)。止血带时间:A组(64.2±18.6)min,短于B组的(75.0±22.1)min(P=0.004)。并发症:A组1例,B组5例(P=0.213)。术后7 d及3个月的VAS:A组分别为(3.9±1.2)分、(2.4±0.8)分,B组分别为(4.5±1.1)分、(2.2±0.9)分(P=0.026、P=0.835)。术后7 d及3个月的膝关节HSS评分:A组分别为(85.4±8.3)分、(90.5±8.7)分,B组分别为(78.5±7.6)、(89.2±6.8)分(P=0.015、P=0.815)。术后实现膝关节90°屈曲的时间:A组为(1.5±0.6)d,B组为(2.2±0.8)d(P=0.042)。结论 TKA中释放止血带会增加患者围手术期失血量,但可能会减少术后并发症的发生,减轻患者早期疼痛反应,有利于早期的功能康复。Objective To explore the influence of different strategies application of tourniquet on perioperative blood loss,postoperative complications,visual analogue scale（ VAS） pain score and the knee function in total knee arthroplasty（ TKA）. Methods 211 patients who underwent TKA were randomly divided into two groups. Group A comprised of 105 patients with early tourniquet releasing for hemostasis and group B consisted of 106 patients with late tourniquet releasing after compressive dressing. Perioperative calculated total blood loss,postoperative complications,VAS score,HSS score in postoperative 7 days and 3 months and the time of acquiring 90° flexion were compared.Results The total blood loss was（ 945 ± 368） ml in group A and（ 725 ± 243） ml in group B,P value was 0. 032,which was significant. Operative time：（ 93. 5 ± 24. 4） min of group A was longer than（ 75. 0 ± 22. 1） min in group B（ P〈0. 001）. Tourniquet time：（ 64. 2 ± 18. 6） min and（ 75. 0 ± 22. 1） min was in group A and B respectively,group A was shorter than group B（ P = 0. 004）. One complication in group A and five complications in group B were detected,P value was 0. 213,which was not significant. The seven days and three months for VAS postoperatively was3. 9 ± 1. 2,2. 4 ± 0. 8 for group A and 4. 5 ± 1. 1,2. 2 ± 0. 9 for group B（ P = 0. 026 and P = 0. 835,respectively）.HSS score about seven days and three months,it was 85. 4 ± 8. 3,90. 5 ± 8. 7 for group A and 78. 5 ± 7. 6,89. 2 ±6. 8 for group B（ P = 0. 015 and P = 0. 815,respectively）. The time for acquiring 90° flexion was（ 1. 5 ± 0. 6） days for group A and（ 2. 2 ± 0. 8） days for group B,which was significant（ P = 0. 042）. Conclusions Releasing tourniquet before wound closure increase perioperative blood loss in the TKA operation. Otherwise,it may reduce the incidence of postoperative complications,alleviate patients＇ pain reaction and achieve early functional rehabilitation.

关 键 词：全膝关节置换术 止血带 失血量 手术后并发症 HSS评分 

分 类 号：R687.4[医药卫生—骨科学] R619[医药卫生—外科学]