止血带释放时机对全膝关节置换术失血的影响

Effect of tourniquet release timing on perioperative blood loss in cemented total knee arthroplasty

目的 探讨止血带释放时机对全膝关节置换术（TKA）失血的影响。方法2006年6月至2008年6月，80例TKA患者随机分为两组，每组40例。A组：释放止血带彻底止血后关闭切口，B组：关闭切口弹力绷带包扎后释放止血带。比较两组患者的失血量、输血例数、手术时间、止血带使用时间及膝关节屈曲度。结果A组术中失血量[（161．5±50．1）mL]多于B组[（70．0±19．4）mL]，术后失血量[（357．8±104．7）mL]少于B组[（467．9±116．0）mL】，总失血量[（516．8±107．9）mL]少于B组[（579．5±140．2）mL]，差异均有统计学意义（P〈0．05）；但两组输血例数差异无统计学意义（P〉0．05）。A组手术时间为（77．7±14．6）min，B组为（73．6±17．5）min，两组比较差异无统计学意义（P〉0．05）。A组止血带使用时间为（69．4±14．4）min，B组为（73．6±17．5）min，两组比较差异无统计学意义（P〉0．05）。术后1周膝关节屈曲A组为93°、B组为84°，术后2周A组为113°、B组为103°，两组比较差异均有统计学意义（P〈0.05）；但8周后A组膝关节屈曲为117°、B组为113°，差异无统计学意义（P〉0．05）。结论释放止血带彻底止血后关闭切口可减少手术总失血量。

Objective To study the effect of tourniquet release timing on perioperative blood loss in cemented total knee arthroplasty （TKA） . Methods From June 2006 to June 2008, 80 TKA patients were randomly allocated into 2 equal groups. In Group A, the tourniquet was released and haemostasis secured before wound closure. In group B, the tourniquet was released after skin closure and compressive bandaging. Results We found a significant difference between the 2 groups in intraoperative （Group A： 161.5±50.1 mL〉 Group 13：70.0±19.4 mL）, postoperative （Group A： 357.8±104.7 mL 〈 group B： 467.9±116.0 mL）and total （Group A： 516.8±107.9 mL 〈 Group B： 579.5±140.2 mL） blood loss （ P 〈 0. 05 ） . But no significant difference was found in blood transfusion, operation time or tourniquet time （ P 〉 0. 05）. In knee flexion, Group A was better than Group B before 2 weeks, but the two were not significantly different after 8 weeks and nearly the same 6 months. Conclusion We recommend tourniquet release and haemostasis before wound closure, as it can reduce total blood loss and avoid possible risks of extended tourniquet.