膝关节置换术中止血带的使用对术后加速康复的影响

Effects of tourniquet use on enhanced recovery after surgery in total knee arthroplasty

背景:全膝关节置换(total knee arthroplasty,TKA)术中使用止血带可减少术中出血,有利于手术操作,但止血带的使用会对患者术后造成一些不利的影响。目的:研究TKA术中止血带的使用对患者术后加速康复的影响。方方法法:选取30例接受同期双侧TKA的患者纳入此研究。受试者随机确定一侧膝关节在TKA术中使用止血带,另一侧膝关节在TKA术中不使用止血带。止血带组在手术开始前将止血带充气,直至皮肤缝合完毕;非止血带组手术全程不使用止血带。观察对比两组股四头肌肌力、膝关节疼痛VAS评分、下肢肿胀率、膝关节主动活动度、手术时间、术中出血量、术后伤口引流量、并发症发生率以及TKA术后X线评价计分。结果:术后1 d、3 d,非止血带组的膝关节疼痛VAS评分在休息和活动时均小于止血带组,均有统计学差异;而术后5 d,非止血带组的膝关节疼痛VAS评分在休息和活动时均小于止血带组,但仅在活动时有统计学差异。术后3 d、5 d,非止血带组的股四头肌肌力大于止血带组,下肢肿胀率低于止血带组。非止血带组的术中出血量多于止血带组。两组术后膝关节主动活动度、手术时间、术后伤口引流量、总显性失血量、术后并发症发生率及X线评价计分无统计学差异。结论:在患者条件及术者手术技术允许的条件下,TKA术中不使用止血带可以减轻术后疼痛和肢体肿胀情况,并有助于术后加速康复,同时不增加并发症发生的风险,不影响假体安装固定质量。

Background： Tourniquet use during total knee arthroplasty（TKA） reduces intraoperative blood loss and facilitates surgical procedures. However, tourniquet use may have a negative impact on patients postoperatively. Objective： To investigate the effects of tourniquet use on enhanced recovery after surgery（ERAS） in TKA. Methods： Thirty patients undergoing simultaneous bilateral TKA were enrolled in this study. Subjects were randomized to receive a tourniquet assisted TKA on one knee while the contralateral knee underwent TKA without tourniquet. In the tourniquet group, the tourniquet was inflated immediately before surgery and deflated after the last suture of the skin. Quadriceps strength, VAS score of the knee, limb swelling index, knee active range of motion, operation time, intraoperative blood loss, drainage, complications and radiographic evaluation score after TKA were observed and compared between groups. Results： The VAS score of the knee in the non-tourniquet group was significantly lower than that in the tourniquet group at rest and on in exercise on day 1and 3 postoperatively. But the VAS score of the knee in the non-tourniquet group was significantly lower than that in the tourniquet group only in exercise on day 5 postoperatively. At 3 and 5 days postoperatively, quadriceps strength in the nontourniquet group was greater than that in the tourniquet group, while the incidence of limb swelling in the non-tourniquet group was lower than that in the tourniquet group. There were no significant differences in knee active range of motion, operation time, postoperative drainage, total blood loss, incidence of complications or postoperative radiographic evaluation score between the two groups. Conclusions： When the condition of patients and operative technique are allowed, TKA without tourniquet can relieve the pain, decrease the limb swelling early postoperatively, and facilitate earlier functional recovery. Besides, it will not increase the risk of complications or affect the implant fixation quality.