全膝置换术止血带与控制性低血压的比较  

Comparison of tourniquet versus controlled hypotension in total knee arthroplasty

作　　者：李兴龙 刘家伟 丁亚 程建军 程功 孙广峰 潘檀 王宏亮 LI Xing-long;LIU Jia-wei;DING Ya;CHENG Jian-jun;CHENG Gong;SUN Guang-feng;PAN Tan;WANG Hong-liang(People's Hospital of Fuyang City,Bengbu Medical College,Fuyang236000,China)

机构地区：[1]蚌埠医学院附属阜阳市人民医院,安徽阜阳236000

出　　处：《中国矫形外科杂志》2024年第5期463-467,共5页Orthopedic Journal of China

基　　金：2021年度阜阳市卫生健康委科研立项课题面上项目(编号:FY2021-009);2022年度安徽省脊柱畸形临床医学研究中心医疗创新基金项目(编号:AHJZJX-GG2022-003);中国红十字基金会科研项目(编号:XM_LHJY2022_05_23)。

摘　　要：[目的]比较止血带与控制性低血压在全膝关节置换中应用的早期结果。[方法]2022年9月—2023年1月125例膝骨性关节炎行单侧全膝关节置换患者纳入本研究。采用随机数字表分为两组,其中,60例使用止血带(TQ组),65例使用控制性低血压(CH组)。比较两组早期临床及检验资料。[结果]两组患者均顺利完成手术,TQ组术中失血量[(60.2±12.7)ml vs(89.1±16.5)ml,P<0.001]显著少于CH组,但前者术后引流量[(160.1±39.4)ml vs(128.0±37.5)ml,P<0.001]、隐性失血量[(550.2±277.7)ml vs(420.4±273.1)ml,P=0.009]、总失血量[(770.5±275.1)ml vs(637.4±271.2)ml,P=0.007]显著多于后者。两组术后膝关节ROM和HSS评分均显著增加(P<0.05),术后5 d及1个月,TQ组膝关节ROM[(95.5±6.4)°vs(100.5±7.1)°,P<0.001;(106.2±8.3)°vs(109.4±7.6)°,P=0.025]和HSS评分[(67.7±5.9)vs(72.3±6.9),P<0.001;(81.1±4.6)vs(83.3±4.5),P=0.010]均显著少于CH组。检验方面,两组患者术前Hb、Hct、APTT、PT、Fib、D-D、CRP、IL-6的差异均无统计学意义(P>0.05)。TQ组术后第1 d Hb、Hct、APTT、PT和术后第3 d Hb、Hct、APTT显著低于CH组(P<0.05),而术后第1 d前者的D-D、CRP、IL-6和术后第3 d Fib、D-D、CRP、IL-6均显著高于后者(P<0.05)。[结论]全膝置换采用控制性低血压可减少总失血量,缓解术后高凝状态,减少炎症反应,促进膝关节功能的早期康复。[Objective]To compare the early results of tourniquet versus controlled hypotension in total knee arthroplasty.[Methods]A total of 125 patients who underwent unilateral total knee arthroplasty for knee osteoarthritis from September 2022 to January 2023 were in⁃cluded in this study,and divided into two groups using the random number table method.Of them,60 patients were treated with tourniquet(the TQ group),while other 65 patients were treated with controlled hypotension(the CH group).The early clinical and laboratory data of the two groups were compared.[Results]The operation was successfully completed in both groups.Although the TQ group had significantly low⁃er intraoperative blood loss than the CH group[(60.2±12.7)ml vs(89.1±16.5)ml,P<0.001],the former proved significantly greater than the latter in terms of postoperative drainage volume[(160.1±39.4)ml vs(128.0±37.5)ml,P<0.001],latent blood loss[(550.2±277.7)ml vs(420.4±273.1)ml,P=0.009],total blood loss[(770.5±275.1)ml vs(637.4±271.2)ml,P=0.007].The ROM and HSS scores significantly in⁃creased in both groups,5 days and 1 month postoperatively compared with those preoperatively(P<0.05).The TQ group was significantly in⁃ferior to the CH group in terms of knee ROM[(95.5±6.4)°vs(100.5±7.1)°,P<0.001;(106.2±8.3)°vs(109.4±7.6)°,P=0.025]and HSS score[(67.7±5.9)vs(72.3±6.9),P<0.001;(81.1±4.6)vs(83.3±4.5),P=0.010]5 days and 1month postoperatively.As for laboratory test,there were no statistically significant differences in preoperative Hb,Hct,APTT,PT,Fib,D-D,CRP and IL-6 between the two groups(P<0.05).The TQ group had significantly lower Hb,Hct,APTT,PT 1 day after surgery,Hb,Hct,APTT 3 days after surgery,whereas significantly higher DD,CRP,IL-6 one day and 3 days postoperatively than the CH group(P<0.05).[Conclusion]Total knee arthroplasty under controlled hypo⁃tension does reduce total blood loss,relieve postoperative hypercoagulability,reduce inflammatory response,and promote early recovery of knee function.

关 键 词：全膝关节置换术 止血带 控制性低血压 早期康复 

分 类 号：R687.4[医药卫生—骨科学]