驱血止血弹性束紧套环在初次全膝关节置换术中应用的疗效

Clinical Efficacy of Sterile Exsanguination Silicone Tourniquets on Primary Total Knee Arthroplasty

目的对比驱血止血弹性束紧套环与气囊止血带在初次全膝关节置换术中的临床疗效以及对术后康复的影响。方法回顾2020年4月至2020年10月于我科行初次全膝关节置换的52例患者,并采用序列研究方法分为两组。4~7月符合条件的25例患者(20例单膝,5例双膝,共30膝)纳入驱血止血弹性束紧套环组,8~10月符合条件的27例患者(24例单膝,3例双膝,共30膝)纳入气囊止血带组。统计术中止血带放松前失血量、总失血量、手术时间、止血带使用时间、输血率、曲马多需求比率、血栓发生率与膝关节活动度。疼痛视觉模拟评分法(visual analogue scale,VAS)用于评价术中视野清晰度、术后大腿疼痛与膝关节疼痛,采用Lovett评分评价股四头肌肌力。结果相较于气囊止血带,驱血止血环可降低术中止血带放松前的失血量(P<0.01),提供良好的视野清晰度(P<0.01),但两组总失血量比较差异无统计学意义(P=0.67)。驱血止血环组止血带使用时间(64.10±4.98)min,手术时间(73.03±6.11)min,深静脉血栓发生率13.33%;气囊止血带组止血带使用时间(70.73±13.13)min,手术时间(79.33±14.57)min,深静脉血栓发生率36.67%,两组比较差异有统计学意义(P=0.01,P=0.04,P=0.04)。术后早期,对于止血部位大腿疼痛、膝关节疼痛、股四头肌肌力与膝关节活动度等方面,驱血止血环具有一定临床优势。其他指标如输血率、曲马多需求比率均没有差异。结论驱血止血环可减少术中失血量,提供清晰的手术视野,缩短止血带使用时间与手术时间,提升手术效率。术后早期,驱血止血环可减少对肢体的挤压损伤,降低大腿疼痛,利于股四头肌肌力与膝关节活动度的恢复,加速患者康复,提升患者满意度。

Objective To compare the clinical efficacy on the accelerated recovery of postoperative patients in Primary TKA with pneumatic tourniquet and a sterile exsanguination silicone tourniquet.Methods In total 50 patients undergoing primary total knee arthroplasty were retrospectively studied from April to October in 2020.With the design of sequential trial,in total 25 patients(20 cases of single knee,5 cases of double knee,a total of 30 knees)qualified were assigned to group sterile exsanguination silicone tourniquet from April to July;total 27 patients(24 cases of single knee,3 cases of double knees,a total of 30 knees)were included into the group of pneumatic tourniquets.Intraoperative blood loss before releasing tourniquet,total blood loss,surgical time,tourniquet use time,allogeneic blood transfusion rates,incidence of deep venous thrombosis and knee active range of motion(ROM)were summarized.Visual clarity of surgical field,thigh pain and knee pain were measured by the Visual Analog Scale.Lovett muscle strength classification standard was adopted to evaluate quadriceps strength.Results Compared to pneumatic tourniquet,the sterile exsanguination silicone tourniquet group could obviously decrease the blood loss before releasing tourniquet(P<0.01).Meanwhile,the excellent visual clarity of surgery field could be acquired in sterile exsanguination silicone tourniquet group with Score(P<0.01).However,there is no significant difference in total blood loss between the two groups(P=0.67).In sterile exsanguination silicone tourniquet group,tourniquet use time(64.10±4.98)min,operation time(73.03±6.11)min,the incidence of deep vein thrombosis was 13.33%.In pneumatic tourniquet group,tourniquet use time(70.73±13.13)min,operation time(79.33±14.57)min,the incidence of deep vein thrombosis was 36.67%.The difference between the two groups was statistically significant(P=0.01,P=0.04,P=0.04).In the postoperative early stage,the thigh VAS score,knee VAS score,quadriceps strength and knee active range of motion in sterile exsanguination silicone tourniquet group were much better than those in pneumatic tourniquet group.There was no significant difference for allogeneic blood transfusion rates and tramadol demand rate between groups.Conclusion A sterile exsanguination silicone tourniquet is an effective method to reduce intraoperative blood loss and provide much visual clarity of surgery field,which is beneficial to improve surgical efficiency and decrease tourniquet use time and and surgical time.In the postoperative early stage,compared to pneumatic tourniquet,sterile exsanguination silicone tourniquet could reduce the crush injury and thigh pain of tourniquet,improve quadriceps strength and knee active range of motion,which is beneficial to faster recovery for patient as well as increasing patient satisfactions.