踝部骨折双切口手术中使用止血带与否的前瞻性随机对照观察  

A prospective randomized controlled clinical study on double incision surgery for ankle fracture with or without tourniquet

作　　者：李铭夫 王军强[1] 孙志坚 李庭[1] 陈依民 韩巍[1] Li Mingfu;Wang Junqiang;Sun Zhijian;Li Ting;Chen Yimin;Han Wei(Department of Orthopaedic Traumatology,Beijing Jishuitm Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院创伤骨科,100035 [2]辽宁省朝阳市第二医院创伤骨科

出　　处：《骨科临床与研究杂志》2022年第5期292-298,共7页Journal Of Clinical Orthopedics And Research

基　　金：北京积水潭医院高层次人才“学科骨干”培养计划(XKGG201802)。

摘　　要：目的 探讨踝部骨折双切口手术中使用止血带与否对治疗效果的影响。方法 选取2017年7月至2019年7月北京积水潭医院创伤骨科连续收治的踝部骨折患者90例,以随机数字表法分为止血带组和非止血带组,每组45例。对非止血带组患者在手术过程中不使用止血带止血,对止血带组患者在非止血带组的治疗基础上使用止血带。对两组患者的血压、手术时间、出血量和手术视野评分等术中指标,下肢肿胀程度、引流量、疼痛视觉模拟评分(VAS)与神经损伤、下肢静脉血栓、切口渗出和感染、肌损伤等并发症的发生率等术后指标以及术后3个月Tinetti平衡与步态量表(Tinetti POMA)、Berg平衡量表(BBS)、踝部功能Olerud Molander(OM)评分和美国矫形足踝协会量表(AOFAS)等踝关节功能评价指标进行比较。采用SPSS 26.0软件对数据进行统计学分析;P<0.05为差异有统计学意义。结果 与非止血带组相比,止血带组患者术中血压和手术视野评分显著提高,出血量显著降低(均P<0.001);术后止血带组患者中足和下肢周长,下肢静脉血栓发生率(17.78%)以及水泡、切口渗出和感染等并发症发生率(44.44%)均高于非止血带组(22.00%,28.89%)(均P<0.05);止血带组患者术后引流量[493(473, 513) ml]和VAS评分[8(6, 8)分]较非止血带组[472(452,495) ml, 6(5,7)分]均显著升高(均P<0.001);术后3个月止血带组患者Tinetti POMA评分、BBS评分、OM评分优良率和AOFAS评分优良率与非止血带组差异均无统计学意义(均P>0.05)。结论 在踝部骨折双切口手术中使用止血带可维持患者术中血压,减少术中出血,使手术视野更加清晰,但是可能带来不可忽视的术后并发症;术中使用止血带与否对踝关节的远期功能没有显著影响;临床工作中应重视止血带使用的安全性和规范性。Objective To conduct a case-control study and explore the use of tourniquets in ankle fracture surgery. Methods From July 2017 to July 2019, 90 patients with ankle fractures who were continuously admitted to the Department of Orthopaedic Traumatology in Beijing Jishuitan Hospital were selected and divided into an tourniquet group and an no-tourniquet group according to the random number table method, with 45 cases in each group. The no-tourniquet group did not use a tourniquet during ankle surgery, and the tourniquet group used a tourniquet on the basis of the no-tourniquet group. The intraoperative indices, postoperative indices, postoperative ankle function recovery and postoperative complications were compared between the 2 groups. Results Compared with the no-tourniquet group, the intraoperative blood pressure and operative field evaluation of the tourniquet group were significantly increased, and the blood loss were significantly decreased, and all of the differences were statistically significant(all P<0.05). After operation, the circumference of midfoot and lower limb of the tourniquet group were greater than that of no-tourniquet group(all P<0.05);The incidence of postoperative deep venous thrombosis of the tourniquet group(13.33%) was higher than that in the no-tourniquet group(6.67%), and the incidence of complications such as blisters, incision exudation and infection(44.44%) was higher than that of the no-tourniquet group(28.89%)(P<0.05). Compared with the no-tourniquet group, the drainage volume[493(473,513)ml] and VAS score[8(6,8)scores] of the tourniquet group were significantly higher(all P<0.05). Three months after operation, there was no significant difference between the 2 groups in the scores of Tinetti POMA, Berg Balance Scale(BBS), OM and AOFAS(all P>0.05). Conclusion In the operation of ankle fracture, the use of tourniquet can maintain the intraoperative blood pressure, reduce the intraoperative bleeding and make the the surgical field clearer, but may bring non-negligible postoperative co

关 键 词：踝骨折 外科手术 止血带 疗效比较研究 手术后并发症 随机对照试验 前瞻性研究 

分 类 号：R687.3[医药卫生—骨科学]