低位止血带在踝关节骨折手术中的应用效果观察

Effect of low tourniquet on ankle fracture surgery

目的探讨低位止血带在踝关节骨折手术中的应用效果。方法回顾性队列研究。纳入2018年4月—2020年5月同济大学附属同济医院踝关节骨折患者44例。其中,男21例、女23例,年龄18~57岁、平均42.8岁。44例患者按止血带捆绑方式分为2组,高位止血带组22例,低位止血带组22例,2组患者均行切开复位内固定术治疗。比较2组患者手术时间、止血带使用时间、术中术后出血量,观察术后止血带压迫部位有无瘀斑、软组织团块、水泡、皮肤溃疡及下肢深静脉血栓形成等并发症情况,术后第1、3、7、14天采用疼痛视觉模拟评分法(VAS)评估患肢疼痛情况,术后4周、12周、6个月、12个月观察患者踝关节屈曲、背伸及踝关节活动度情况,并采用美国足踝外科协会(AOFAS)踝-后足评分标准评定疗效。结果2组患者均顺利完成手术,手术时间、止血带使用时间及出血量比较,差异均无统计学意义(P值均>0.05)。高位止血带组术后止血带压迫部位出现瘀斑1例、软组织团块1例,下肢血管彩超检发现深静脉血栓形成1例;低位止血带组无一例相关并发症发生。2组患者术后第1、3、7天患肢疼痛VAS评分比较,差异均无统计学意义(P值均>0.05);而术后第14天,低位止血带组VAS评分低于高位止血带组,差异有统计学意义(t=2.41,P=0.020)。44例患者均获随访,随访时间6~24月,平均15.8个月。随访期间,2组患者切口无感染,均一期愈合;无内固定松动、断裂等并发症发生。2组患者骨折愈合时间差异无统计学意义(t=0.94,P=0.351)。术后4周,低位止血带组患者踝关节屈曲、背伸及踝关节活动度、AOFAS踝-后足评分均高于高位止血带组,差异均有统计学意义(P值均<0.05),而术后12周、6个月、12个月时,差异均无统计学意义(P值均>0.05)。结论低位止血带用于踝关节骨折手术在确保良好手术界面的同时,能提升术后早期踝关节的活动度及临床功能,减少传统止血带导致的患肢疼痛及相关并发症的发生,是一种值得推荐的新方法。

Objective To investigate the effect of low tourniquet on ankle fracture surgery.Methods The data of 44 patients with ankle fracture(21 males and 23 females)who were admitted between April 2018 and May 2020 in Tongji Hospital Affiliated to Tongji University were retrospectively analyzed.The patients were aged 18-57 years(average of 42.8 years).The patients were equally divided into two groups,namely,the high and low tourniquet groups,according to the location of tourniquet binding.Both groups were treated with open reduction and internal fixation.Operation time,tourniquet time,intraoperative and postoperative bleeding,and complications(ecchymosis,soft tissue mass,blister,skin ulcer,and lower extremity deep venous thrombosis)were also observed.Pain in the affected limb was evaluated by visual analog scale(VAS)on the 1st,3rd,7th,and 14th days after operation.Ankle flexion,back extension,ankle range of motion,and ankle-hindfoot function with American Orthopedic Foot and Ankle Association(AOFAS)score were observed for 4 weeks,12 weeks,6 months,and 12 months postoperatively.Results The operation was successfully completed in both groups.No significant differences in operation time,tourniquet time,and bleeding volume were observed(all P values>0.05).In the high tourniquet group,one case of ecchymosis at the tourniquet compression site,one case of soft tissue mass,and one case of deep venous thrombosis were found by color Doppler ultrasonography.No related complications occurred in the low tourniquet group.No significant differences in the VAS scores of limb pain between the two groups were noted on the 1st,3rd,and 7th days after operation(all P values>0.05).On the 14th day after operation,the VAS score of the low tourniquet group was lower than that of the high tourniquet group(t=2.41,P=0.020).All patients were followed up for 6-24 months with an average of 15.8 months.During follow-up,incisions in the two groups had no infection and healed.No complications,such as loosening and fracture of the internal fixation,occurred.No significant difference in fracture healing time was found between the two groups(t=0.94,P=0.351).At 4 weeks after operation,the ankle flexion,back extension,ankle range of motion,and AOFAS ankle hindfoot score of the low tourniquet group were significantly higher than those in the high tourniquet group(all P values<0.05).No significant differences in ankle flexion,back extension,ankle range of motion,and AOFAS ankle-hindfoot score were found between the two groups at 12 weeks,6 months,and 12 months after operation(all P values>0.05).Conclusion The application of low tourniquet in ankle fracture surgery can ensure a good operation interface,improve the early range of motion and clinical function of the ankle joint after operation,and reduce the occurrence of limb pain and related complications caused by traditional tourniquet.Thus,low tourniquet is a new method worthy of recommendation.