不同止血带释放模式在老年全膝关节置换术病人中的应用效果

Effects of different tourniquet release pattern in elderly patients undergoing total knee arthroplasty

目的 研究不同止血带释放模式在老年全膝关节置换术(TKA)中的效果,优化止血带应用方案。方法 选取2019—2021年南京市六合区人民医院骨科拟行初次单侧TKA的93例老年病人,随机分为A、B、C三组:A组全程使用止血带+常规释放,B组半程使用止血带+常规释放,C组半程使用止血带+阶梯释放,每组各31例。比较3组手术时间、失血量、术后VAS评分、关节活动范围(ROM)和并发症发生情况。结果 3组手术时间差异无统计学意义(P>0.05)。C组术中失血量、隐性失血量和总失血量高于A组,但低于B组(P<0.05);C组术后引流量小于A组和B组(P<0.05)。术后第1、7、14天,C组VAS评分均低于A组和B组(P<0.05);术后第7、14天,C组患膝ROM均大于A组和B组(P<0.05)。3组切口皮肤水泡、伤口持续渗液及深静脉血栓发生率差异均无统计学意义(P>0.05),但C组并发症总发生率显著低于A组和B组(均P<0.05)。结论 与常规止血带释放方式相比,TKA术中采取半程使用+阶梯释放止血带方案能够减轻术后患肢疼痛、增加膝关节活动度,促进老年病人的早期康复。

Objective To investigate the effects of different tourniquet release modes in the elderly patients undergoing total knee arthroplasty(TKA)and optimize the application scheme of tourniquets.Methods Ninety-three elderly patients who would undergo unilateral TKA in Department of Orthopedics,Luhe People’s Hospital of Nanjing,from 2019 to 2021 were selected,and they were randomly divided into 3 groups:Group A(receiving full duration of tourniquet application and routine release),Group B(receiving half duration of tourniquet application and routine release)and Group C(receiving half duration of tourniquet application and staged release),with 31 cases in each group.The operation time,blood loss volume,postoperative visual analogue scale(VAS)scores,knee joint range of motion(ROM)and the incidence of complications were compared among the three groups.Results There was no significant difference in operation time among the three groups(P>0.05).Compared with Group C,the intraoperative blood loss,hidden blood loss and total blood loss were lower in Group A,but higher in Group B;the postoperative drainage volume was higher in Group A and B(P<0.05).On the 1st,7th,and 14th day after surgery,the VAS scores in Group C were lower than those in Group A and B(P<0.05);On the 7th and 14th day after surgery,the level of ROM in Group C was higher than that in Group A and B(P<0.05).There were no differences in the incidence rates of skin blisters,incision seepage,and deep vein thrombosis among the three groups,but the total incidence rate of complications in Group C was lower than that in Group A and B(P<0.05).Conclusions Compared with conventional release mode of tourniquet during TKA,half duration of tourniquet application and staged release can reduce the postoperative pain,increase the knee ROM,and promote early recovery in the elderly patients.