骨水泥型全膝关节置换术中止血带应用策略的研究  

Comparison of tourniquet release time in cemented total knee arthroplasty: a retrospective clinical study

作　　者：虞宵 章鸿 繆烨 张向鑫 陈广祥[1] 李力[1] Yu Xiao;Zhang Hong;Miao Ye(Department of Orthopedics,Suzhou Municipal Hospital,Suzhou Jiangsu,215002,China)

机构地区：[1]南京医科大学附属苏州市立医院本部骨科(关节外科),江苏苏州215002

出　　处：《生物骨科材料与临床研究》2018年第3期42-44,49,共4页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：2017年江苏省高层次卫生人才“六个一工程”拔尖人才项目(LGY2017008);2016年苏州市临床重点病种诊疗技术专项项目(LCZX201618)

摘　　要：目的对比研究不同止血带策略在骨水泥型全膝关节置换术中应用的安全性和有效性。方法从2014年3月到2017年3月,回顾性分析131例接受初次单侧骨水泥型全膝关节置换术的患者,按照止血带使用时间分为对照组和实验组。对照组包含72名病人,在假体安装完成后切口缝合完全止血前松开止血带,而实验组的59名病人在切口缝合,患肢用弹性绷带包扎后松开止血带。本研究分析相关临床数据,包括手术时间、止血带时间、显性失血量、隐性失血量、血红蛋白降低和术后并发症。结果对照组和实验组的显性失血量分别为(750.6±91.4)m L和(615.2±52.1)mL(P<0.05);隐性失血量分别为(751±252)mL和(532±281)mL(P<0.05)。对照组有明显的显性及隐性失血量增加(P<0.05)。对照组和实验组分别出现9例和13例轻微并发症,两组之间没有统计学差异(P=0.15),此外两组病人均未出现严重并发症。结论全膝置换手术全程应用止血带可以明显减少显性及隐性失血量,并且没有明显增加感染、皮缘坏死、下肢水肿和深静脉血栓等并发症的风险。Objective To compare the safety and efficacy of different tourniquet strategies in cemented total knee arthro- plasty （TKA） Methods From Mar 2014 to Mar 2017, 131 patients who underwent cemented TKA were collected and divided into group C （control group） and group E （experimental group）. Group C included 72 patients with tourniquet release before wound closure to achieve complete hemostasis and group E consisted 59 patients with tourniquet inflated until the leg wrapped with elastic bandages. Clinical data including surgery time, tourniquet time, dominant blood loss, hidden blood loss, hemoglobin drop and postoperative complications was analyzed. Results The dominant blood loss was （750.6±91.4） mL in group C and （615.2±52.1） mL in group E respectively （P〈0.05）. The hidden blood loss was （751±252） mL in group C and （532±281） mL in group E respectively （P〈0.05）. Significant increase of dominant and hidden blood loss during operative period and decline of tourniquet time were observed in group C （P〈0.05）. As for minor complications, a total of 22 patients were observed with 9 in group C and 13 in group E, and there was no significant difference between these two groups （P=0.15）. No major complications were recorded. Conclusion The whole course tourniquet application lead to less blood loss and hemoglobin drop. There was no obvious risk increase for both major and minor postoperative complications, such as infection, flap margin necrosis, lower extremity edema and deep vein thrombosis.

关 键 词：全膝关节置换术 止血带 失血量 并发症 

分 类 号：R681.8[医药卫生—骨科学]