全膝关节置换术中使用止血带对术后大腿肌肉萎缩的影响  

The effect of tourniquet in total knee arthroplasty on postoperative thigh muscle atrophy

作　　者：王军[1] 张育民[1] 马涛[1] 王涛[1] 程辉光 宋伟[1] Wang Jun;Zhang Yumin;Ma Tao(Hip Joint Ward,Arthropathy Hospital,the Affilialed Honghui Hospital of Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院关节病医院髋关节病区,710054

出　　处：《美中国际创伤杂志》2021年第3期12-16,共5页U.S.Chinese International Journal of Traumatology

摘　　要：目的:应用MRI对TKA术后早期大腿肌肉体积进行研究,评估止血带对大腿肌肉萎缩影响程度、时间及对膝关节功能的影响。方法:选取我院关节外科2017年1月至2018年1月单膝关节骨性关节炎患者68例,均为初次行单侧TKA术。随机分为两组,术中未使用止血带的32例(非止血带组),术中使用止血带的36例(止血带组)。术前、术后1个月、3个月、6个月、12个月分别行MRI检查测两组患者手术侧大腿肌肉体积、记录膝关节VAS及KSS评分,并统计结果。用统计软件对数据进行统计分析,对各时间段肌肉萎缩程度、时间、疼痛及功能评分进行比较,得到的结果进行讨论。结果:TKA术后,非止血带组各时间段大腿肌肉体积未见明显差异,而止血带组大腿肌肉体积有明显差异(P<0.001)。术后1个月,非止血带组大腿体积术前与术后无明显差异(P<0.001),但术后1个月,止血带组大腿体积减少约20%(P<0.001)。术后非止血带组KSS评分显著高于止血带组,而VAS评分明显低于止血带组(P<0.001)。随访3个月止血带组大腿肌肉体积有所增加,而随访12个月时止血带组大腿肌肉体积测量值基本恢复至术前。结论:TKA术中使用止血带可造成术后大腿肌肉萎缩,增加术后疼痛,并延迟膝关节功能恢复。因此,在TKA术中应谨慎使用止血带,可采用其他必要的替代方法,以减少术中出血。Objective:To evaluate the effect of tourniquet in total knee arthroplasty on postoperative thigh muscle atrophy by using MRI.Methods:From January 2017 to January 2018,68 patients with knee osteoarthritis underwent unilateral primary TKA.All patients were randomly divided into two groups,tourniquet did not use during the operation in 32 cases(non-tourniquet group)and used in 36 cases(tourniquet group).Before operation,1 month,3 months,6 months and 12 months after operation,MRI examinations were performed to measure the volume of the thigh muscle on the operation side of two group's patients,VAS score and KSS score of the knee joint were recorded.Use statistical software to perfonn statistical analysis on the data.The degree and time of muscle atrophy,pain and functional scores in each time period were compared,the results were obtained and discussed.Results:After TKA,there was no significant difference in thigh muscle volume in the non-tourniquet group at each time period,but there was a significant difference in the tourniquet group(P<0.001).One month after the operation,there was no significant difference in the thigh volume before and after operation in the non-tourniquet group(P<0.001),but the thigh volume of the tourniquet group was reduced by about 20%(P<0.001).The KSS score of the non-tourniquet group was significantly higher than that of the tourniquet group,while the VAS score was significantly lower than that of the tourniquet group(P<0.001).The thigh muscle volume of the tourniquet group increased at 3-months follow-up and basically recovered to the preoperative value at the 12-month follow-up.Conclusion:The use of tourniquets during TKA can cause postoperative thigh muscle atrophy,increase postoperative pain,and delay the recovery of knee joint function.Therefore,tourniquets should be used with caution during TKA,and other necessary alternative methods can he used to reduce intraoperative bleeding.

关 键 词：止血带 肌肉萎缩 膝关节置换术 大腿 

分 类 号：R47[医药卫生—护理学]