全膝关节表面置换术中止血术后自体血回输的比较

Comparison of the autologous blood transfusion after hemostasis during total knee arthroplasty

背景:以往研究多为全程止血带技术与骨水泥黏合假体时应用止血带的中途止血带技术作临床比较。目的:观察全膝关节表面置换中全程运用止血带和关闭切口前放松止血带电凝及骨蜡止血方法结合自体血回输对置换后早期患者临床症状及患肢功能的影响。方法:60膝骨性关节炎患者行全膝关节表面置换,其中30膝应用全程止血带技术(止血带组),30例关闭切口前放松止血带,电凝及骨蜡止血(电凝止血组),置换后两组均安放自体血回输器,通过比较两组的出血量、引流量、置换后临床症状及功能的KSS评分等对两种止血带使用方法的早期临床效果加以评价。结果与结论:两种技术置换中出血量止血带组(50±10)mL少于电凝止血组(180±120)mL(P<0.05);引流量止血带组(237±83)mL少于电凝止血组(285±215)mL(P<0.05)。早期美国膝关节协会评分(KSS)两组差异无显著性意义,关节血肿发生率及下肢静脉血栓发生率差别不显著。结果提示,全膝关节表面置换中关闭切口前电凝止血较全程止血带技术出血较多,置换后引流量也较多,置换后早期临床症状及患肢功能无显著差别。

BACKGROUND：Previous studies often focus on the comparison between the entire tourniquet technology and halfway tourniquet technology which used the tourniquet when the bone cement combined with the prosthesis.OBJECTIVE：To research the influence of clinical symptoms and limb function on postoperative patients between the entire process of tourniquet and tourniquet released electric coagulation and bone wax hemostatic method before the incision is closed,both combined with autologous blood transfusion in total knee arthroplasty.METHODS：Sixty cases of knee osteoarthritis patients who underwent total knee arthroplasty were selected for research.Thirty cases were treated with entire process of tourniquet（tourniquet group） and 30 cases were treated with relax tourniquet before wound closing,and hemostasis using electric coagulation and bone wax respectively（electric coagulation group）.After the total knee arthroplasty,the autologous blood transfusion devices were placed in the patients of two groups.The early clinical effect and affected limb function of patients in two groups were evaluated by comparing the amount of bleeding and draining,the American knee society knee score of clinical symptoms and function postoperatively.RESULTS AND CONCLUSION：The intraoperative blood loss of tourniquet group（50±10） mL was lower than that of electric coagulation group（180±120） mL（P 0.05）;the drainage flow of tourniquet group（237±83） mL was lower than that of electric coagulation group（285±215） mL（P 0.05）.There was no significant difference of early American knee society knee score,and the difference of joint hematoma occurring rate and lower extremity venous thrombosis incidence was not significant.In total knee arthroplasty,the intraoperative bleeding and postoperative drainage volume of the hemostatic method before closing the incision is more than that of the entire process of tourniquet,and there is no significant difference of the early postoperative clinical symptoms and limb function.