全膝关节置换止血带不同应用方式研究

Study on Different Methods of Total Knee Arthroplasty

目的：探讨全程使用止血带与前半程应用方法对患者全膝关节置换术（TKA）手术操作影响、术后凝血功能及术后肢体活动及康复的影响.方法：选择因严重骨关节炎需行全膝关节置换术（TKA）治疗而就诊的的患者180例,按照治疗办法随机分为2组,观察组：采取在前半程使用止血带,即在切口关闭前释放止血带进行彻底止血,对照组：采取全程使用止血带,即在切口关闭后弹力绷带加压包扎后释放止血带进行彻底止血.记录手术总耗时和止血带使用时间,记录术中失血量,计算术后总失血量,并在膝关节置换术后第5、8、14天进行疼痛视觉模拟评分（VAS）检查.结果：对照组手术时间56.7±10.2分钟,出血17.3±6.7ml,平均住院4.1±5.0天;观察组手术时间75.3±9.7分钟,出血75±14.7ml,平均住院5.4±7.2天.术后随访,对照组出现1例患者发生骨水泥渗漏,观察组未出现骨水泥渗漏,2组患者未发现假体移位、脱落的现象.VAS评分方面,对照组、观察组患者术前评分无差异,术后均显著下降,对照组术后8天VAS评分出现升高,至术后14天评分趋于稳定.观察组术后VAS评分持续下降,各时间点均显著低于对照组（P＜0.001）.结论：全程使用止血带较半程使用导致的术后肢体疼痛更加显著,且术后存在骨水泥渗漏的危险隐患,半程使用止血带值得临床推广应用.

Objective ：To investigate the full use of tourniquet and half before the apphcation method for patients with total knee arthro- plasty （TKA） operation, postoperative coagulation function and postoperative physical activity and rehabilitation effect. Methods： Due to severe osteoarthritis undergoing total knee arthroplasty （TKA） treatment and treatment of the 180 patients according to treatment were ran- domly divided into 2 groups, the observation group： take use of tourniquet in the first half, namely in the incision closed before the release of the tourniquet for hemostasis, the control group： take full use of tourniquet in wound closure after elastic bandage The release of the tourniquet thoroughly hemostatic bandage were recorded. Total time and tourniquet time, intraoperative blood loss, postoperative blood loss calculation of total knee arthroplasty, and in 5,8 after 14 days of visual analogue scale （VAS） examination. Results： In the control group, the operation time （56.7 ± 10.2） min bleeding, （17.3 ± 6.7） ml, the average length of （4.1 ± 5） d; the operation time of the observation group （75.3 ± 9.7） rain, bleeding （75 ± 14.7） ml, the average length of （5.4 ± 7.2） d. follow-up after opera- tion, the control group of 1 Patients with bone cement leakage occurred in the observation group, no leakage of bone cement, two groups of patients found no prosthesis shift, phenomenon of. VAS score, shedding control group, observation group patients preoperative score no difference after operation were significantly decreased, the control group after 8 days of VAS score increased to 14 days after operation the score tends to be stable. The patients in the observation group VAS score decreased continuously, each time point was significantly lower than that of control group （P 〈0.001 ）. Conclusion： the full use of tourniquet is half caused by postoperative limb pain was significantly more dangerous, hidden trouble and postoperative bone cement leakage, half a tourniquet it is worthy of clinical application Use.