比较全膝关节置换术中不同止血带放松方式对失血的影响  

Effect of different tourniquet releasing strategy on blood loss in total knee arthroplasty

作　　者：李杨[1] 卢猛 田华[1] 李子剑[1] 张克[1] 

机构地区：[1]北京大学第三医院骨科,100191 [2]辽阳市第三人民医院骨科

出　　处：《中华医学杂志》2017年第41期3219-3224,共6页National Medical Journal of China

摘　　要：目的比较在全膝关节置换术（TKA）中使用不同止血带放松方式对患者术后失血和输血的影响。方法回顾性收集2015年1月至2016年12月诊断为原发性骨性关节炎，并在骨科由3个不同的手术工作组完成的单侧、初次TKA手术的患者共484例；其中A组于截骨完成后放松止血带进行止血，在使用骨水泥之前再次使用止血带至手术结束，B组手术全程使用止血带，C组安放假体后放松止血带直至手术结束。比较3组患者术后的引流量、血红蛋白的丢失量、总失血量、隐性失血量以及输血率的差异。结果A组患者在术后第1天血红蛋白丢失量、引流量和术后第3天总失血量上要略多于其他两组，B组患者在术后第3天血红蛋白丢失量和术后3d隐性失血量上要略多于其他两组，C组患者在总失血量和隐性失血量最少。所有患者中共29例接受了输血治疗（A组10／165，6．1％；B组11／177，6．2％；C组8／142，5．6％）。3组患者手术后的引流量（P=0．496）、血红蛋白丢失量（P=0．242）、总失血量（P=0．390）、隐性失血量（P=0．204）和输血率（P=0．976）均差异无统计学意义。结论在氨甲环酸、非负压引流、弹力绷带加压包扎、局部冰敷等综合性止血措施的常规应用下，膝关节置换中是否放松止血带以及是否进行局部止血对术后的出血量和输血率没有显著影响。Objective To explore the influences on peri-operative blood loss and postoperative blood transfusion in primary total knee arthroplasty when using different methods to release the pneumatic tourniquet. Methods From January 2015 to December 2016, 484 patients with osteoarthritis were enrolled, undergoing primary unilateral total knee arthroplasty in the Orthopedics Department of Peking University Third Hospital. Retrospective data was used, and all the patients had been operated on by three independent working groups. Group A was the strategic tourniquet release group. After the completion of all osteotomy and soft tissue balance, the tourniquet was released for five minutes for coagulation of bleeding tissue and was then inflated again before component cementation until1 the end of the operation. In Group B, full-time tourniquet usage was applied to patients, and was just released post wound closure and pressure dressing. In Group C, the tourniquet was inflated from the beginning of incision to the end of cementation. It was then released after the prosthesis was cemented. A series of data in these three groups were observed and recorded, including output of drain, decrease of hemoglobin level in the first and third day after operation, the total measured blood loss, the hidden blood loss, the number of transfused patients, and the rates of allogenic blood transfusion. Results The decrease of hemoglobin level in the first day after operation, the output of drain and the total level of measured blood loss were slightly higher in Group A. The decrease of hemoglobin level in the third day after operation and the hidden blood loss was slightly higher in Group B. Group C had the lowest total measured blood loss and hidden blood loss among the three groups. However, no significant differences of outcomes were observed among these groups. A total of 29 patients received blood transfusion（Group A 10/165, 6. 1% ; Group B 11/177, 6. 2% ; Group C 8/142, 5.6% ）. There was no significant differences among the three groups

关 键 词：关节成形术 置换 膝 止血带 失血 

分 类 号：R687.4[医药卫生—骨科学]