非全程应用止血带对关节镜联合胫骨高位截骨术围手术期结果的影响

Effect of non-whole time tourniquet application on perioperative outcomes of arthroscopic combined high tibial osteotomy

目的探讨关节镜联合胫骨高位截骨术中非全程使用止血带对临床效果的影响。方法回顾性分析2018年6月至2022年1月于海南医学院第一附属医院行关节镜联合胫骨高位截骨术患者资料,根据纳入与排除标准,纳入研究72例,分为全程使用止血带组38例,仅在关节镜探查阶段使用止血带组34例,比较两组患者的围手术期指标。结果两组患者手术时间、住院时间等无显著性差异(P>0.05);在术后血红蛋白、红细胞压积、引流量、失血量及输血例数等方面无显著性差异(P>0.05);非全程使用止血带组术后早期疼痛评分较低且术后第3天活动度更好(P<0.05);非全程使用止血带组大腿疼痛发生率更低(P<0.05);其他并发症两组患者无显著性差异(P>0.05)。结论胫骨高位截骨术中仅在关节镜探查阶段使用止血带不会增加术后失血量、手术时间及住院时间;且可以减轻术后早期膝关节及止血带部位疼痛,有利于术后早期膝关节功能锻炼,不会增加并发症发生率。

Objective To investigate the effect of non-whole-time application of tourniquet in arthroscopy combined with high tibial osteotomy on clinical outcomes.Methods Clinical data of patients who underwent arthroscopic combined tibial high osteotomy in our hospital from June 2018 to January 2022 were retrospectively analyzed,and a total of 72 patients were included in this study according to the inclusion and exclusion criteria,which were divided into 38 cases in the whole time tourniquet application group and 34 cases in the tourniquet application group only in the arthroscopic exploration stage,and the perioperative indicators were recorded and compared between the two groups.Results(1)There was no statistical difference in terms of operative time and hospitalization days(P>0.05).(2)There was no statistical difference in terms of postoperative hemoglobin,hematokrit,drainage volume,blood loss and transfusion rate between the two groups(P>0.05).(3)The non-whole-time tourniquet group had lower pain scores in the early postoperative period and could achieve better range of motion on the third postoperative day(P<0.05).(4)There was less incidence of thigh pain in the non-whole-time tourniquet group(P<0.05),but there was no statistical difference in other complications between the two groups(P>0.05).Conclusions The results suggest that the use of tourniquet only in the stage of arthroscopic exploration will not increase the postoperative blood loss,operation time and hospital stay after high tibial osteotomy.However,it can reduce the pain of knee and tourniquet site in the early postoperative period,which is conducive to the early postoperative functional recovery,and will not increase the incidence of complications.