应用止血带和不用止血带行全膝关节置换术的对比研究

A comparative study of total knee replacement with and without a tourniquet

目的:比较应用止血带和不用止血带行全膝关节置换术(TKA)术中出血量、术后引流量、术后疼痛及相关炎症指标的影响。方法:选取2019年6月至2021年6月期间某医院收治的158例初次单侧TKA患者为研究对象,将患者采用简单随机法分为应用止血带组和不应用止血带组,各79例。其中应用止血带组患者术中使用充气止血带,不应用止血带组术中使用电刀止血。比较两组围术期失血量情况,并比较两组术前(T0)、术后12h(T1)、术后1d(T2)、术后3d(T3)、术后5d(T4)的血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平、视觉模拟疼痛(VAS)评分、患肢大腿周径。结果:两组患者的术中失血量、术后24h血红蛋白、术后24h红细胞比容、输血例数比较无明显差异(P>0.05),两组患者T0时刻血清IL-6、TNF-α、MDA、SOD水平、VAS评分、患肢大腿周径比较无明显差异(P>0.05)。应用止血带组预估失血量低于不应用止血带组,术后引流量多于不应用止血带组,差异有统计学意义(P<0.05)。T1~T4时刻两组患者的血清IL-6、TNF-α、MDA水平、VAS评分、患肢大腿周径均先升高后降低,术后3d达到顶峰,且T1~T4各时刻应用止血带组均高于不应用止血带组;T1~T4时刻两组患者的血清SOD水平均先降低后升高,术后3d达到最低值,且T1~T4各时刻应用止血带组均低于不应用止血带组,差异统计学有意义(P<0.05)。结论:TKA术中使用止血带会促进机体释放炎症因子,促进氧自由基异常,进而增大术后引流量,增加疼痛感,造成患肢肿胀,不利于术后恢复。

Objective:With the application of tourniquets in TKA surgery,most scholars have found that ischemiareperfusion injury caused by tourniquets can cause early postoperative pain,limb swelling,nerve palsy,wound swelling.Inability to carry out early rehabilitation training smoothly,which has a significant adverse effect on postoperative recovery.To compare the effects of total knee arthroplasty(TKA)with and without tourniquet,so as to provide a reference for future clinical treatment.Methods:158 patients with primary unilateral TKA treated in our hospital from June 2019 to June 2021 were selected as the research object.The patients were randomly divided into tourniquet group and no tourniquet group,with 79 cases in each group.The patients in the tourniquet group used inflatable tourniquet during operation,and the patients in the non tourniquet group used electric knife to stop bleeding during operation.The perioperative blood loss of the two groups was counted and compared.Enzyme-linked immunosorbent assay were used to detect and compare the two groups before operation(T0),12 h after operation(T1),1 d after operatiou(T2),and 3 d after operation(T3).The level of serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),malondialdehyde(MDA)and superoxide dismutase(SOD)on the 5 th day(T4)after surgery were measured by the patients’own perception assessment visual analog pain(VAS)score and comparison,and at each time,point were measured and compared with the patient’s affected limb thigh circumference using a meter ruler.Results:There were no significant differences in intraoperative blood loss,24 h postoperative hemoglobin,24 h postoperative hematocrit and number of blood transfusion cases between 2 groups(P>0.05).There were no significant differences in serum IL-6,TNF-α,MDA,SOD levels,VAS score and circumference of the thigh of the affected limb between 2 groups at TO(P>0.05).The estimated blood loss in the tourniquet group was lower than that in the control group,and postoperative drainage was higher than that in the control group,with significant differences(P<0.05).The level’s of IL-6,TNF-α,MDA,VAS score and circumference of the thigh of the affected limb were firstly increased and then decreased in both groups at T1~T4,and reached the peak at the third day postoperatively,and the tourniquet group was higher than the control group at all times during T1~T4.At T1~T4,the serum SOD level in both groups decreased were firstly decreased and then increased,and reached the lowest value at the third day postoperatively,and the tourniquet group was lower than the control group at each time from T1~T4,the difference was significant(P<0.05).Conclusion:The use of tourniquet during TKA can promote the release of inflammatory factors and abnormal oxygen free radicals,thus increasing postoperative drainage,increasing pain and causing swelling of affected limbs,which is not conducive to postoperative recovery.However,some scholars in the past have found that intermittent use of tourniquets is beneficial to reduce inflammation,surgical complications,and limb swelling,but does not significantly increase the total bleeding of the patient.Like this study,it does not effectively reduce the bleeding of the patient.Therefore,it is effective for hemostasis.Different methods of belt application may produce different effects,which should be further explored in clinical practice in the future.