止血带的使用方式对膝关节置换术失血量和手术时间的影响

The effects of manipulation styles of tourniquet on blood loss and operation time in total knee arthroplasty

目的探讨不同止血带使用方式对全膝关节置换术中、术后失血量的影响及意义。方法 2006年5月至2009年4月行单侧全膝关节置换术的膝关节骨关节炎患者88例,排除凝血机制异常者,患者根据止血带使用方式不同分为手术开始时开始使用组和安装假体时开始使用组,手术开始时开始使用组46例,安装假体时开始使用组42例,其他操作两组相同,记录手术时间、止血带使用时间,记录术中失血量、术后引流量,计算总失血量和隐形失血量。用两独立样本t检验比较两组间的差异。结果手术开始时开始使用组:手术时间75～140min,平均95.9min;止血带使用时间54～105min,平均65.2min。安装假体时开始使用组:手术时间85～150min,平均98.2min;止血带使用时间18～30min,平均24.1min。术中失血量:手术开始时开始使用组132～640ml,平均251.8ml;安装假体时开始使用组320～965ml,平均570.5ml,术中失血量有统计学意义(P<0.01)。术后引流血量:手术开始时开始使用组560～1310ml,平均630.3ml;安装假体时开始使用组470～1190ml,平均576.9ml,两组间比较有统计学意义(P<0.05)。总失血量:手术开始时开始使用组平均1371.7ml,安装假体时开始使用组平均1419.3ml,两组比较总失血量无统计学意义(P>0.05)。隐形失血量:手术开始时开始使用组574.7ml,安装假体时开始使用组437.3ml,隐形失血量比较有统计学意义(P<0.05)。手术开始时开始使用组发生肌肉疼痛4例,神经麻痹1例,对照组未发生使用止血带发生的并发症。结论手术开始时开始使用组可减少术中失血,提供良好的手术视野利于手术操作,但术后失血较多,尤其是隐形失血量较多,对总失血量无明显影响。止血带使用时机对手术时间无影响。

Objective To explore the effects of manipulation styles of tourniquet on blood loss in total knee arthroplasty（TKA）. Methods From May 2006 to April 2009, 88 patients underwent primary unilateral TKA. 46 patients were initiated with tourniquet when operation was started and 42 patients were initiated with it when the prosthesis was installated. Operation time, tourniquet time, the volume of intraoperative blood loss, and postoperative drainage were recorded. The amount of total blood loss and the invisible blood loss were calculated. Results The average operation time of the group in which tourniquet initiated at the start of operation, was 95.9 minutes, and as for the group in which tourniquet initiated when tile prosthesis was installed, the time was 98.2 minutes. In the volume of intraoperative blood loss, there was significant difference between the two groups （ P 〈 0.05 ）. The hidden blood loss had significant difference between both groups （P 〈0. 05）. However, there were no difference in the operation time, and amount of total blood loss （P 〉 0. 05）. Conclusions The tourniquet initiated when operation starts can reduce intraoperative blood loss. However, postoperative blood loss, especially in hidden blood loss increased. There was no significant effect on total blood loss and operation time between different timing of tourniquet use.