膝骨关节炎患者全膝关节置换术中应用止血带对下肢肌力及临床结果的影响

Effects of tourniquet on the strength of lower limb muscles and clinical outcomes in total knee arthroplasty of patients with knee osteoarthritis

目的:探讨膝骨关节炎患者全膝关节置换术中应用止血带对下肢肌力及临床结果的影响。方法:选取2019年6月至2020年6月收治的膝骨关节炎行全膝关节置换术患者60例,分为止血带组和非止血带组各30例。记录总失血量、术中出血量、术后24 h引流量、术后第3日隐性失血量;记录两组患者术前、术后1个月和术后3个月股四头肌(伸肌)和腘绳肌(屈肌)的等速肌力值,包括峰值力矩(PT)、总功量(TW);记录两组患者术前、术后1个月和术后3个月的美国膝关节协会评分(KSS)、疼痛视觉模拟评分(VAS)。结果:止血带组和非止血带组总失血量和引流量差异无统计学意义(P>0.05),而术中失血量止血带组少于非止血带组,隐性失血量止血带组多于非止血带组,差异有统计学意义(P<0.05);术前、术后1个月和术后3个月两组患者股四头肌(伸肌)和腘绳肌(屈肌)的等速肌力值、KSS评分、VAS评分的差异无统计学意义(P>0.05)。结论:膝骨关节炎患者全膝关节置换术中使用止血带能够提供清晰的手术视野,术后短期内对股四头肌和腘绳肌的肌力、膝关节功能无明显影响,术中可以选择使用止血带。

Objective:To evaluate the efficacy of tourniquet application on the strength of lower limb muscle and clinical outcomes during total knee arthroplasty.Methods:Totally 60 patients with knee osteoarthritis who were admitted into our hospital from June 2019 to June 2020.Underwent total knee arthroplasty were selected.The patients were divided into tourniquet group and non-tourniquet group,with 30 cases in each group.Isokinetic muscle strength(peak torque and total power)of quadriceps and hamstring muscles,Knee Society Score(KSS)and visual analogue scale(VAS)were recorded preoperatively and at 1 and 3 months after operation.Intraoperative blood loss,total postoperative blood loss,24-hour drainage volume and hidden blood loss on the 3rd day after the operation were recorded.Results:There were no significant differences in total blood loss and 24-hour drainage volume between the tourniquet group and the non-tourniquet group(P>0.05).Intraoperative blood loss in the tourniquet group was less than that in the non-tourniquet group,and hidden blood loss in the tourniquet group was higher than that in the non-tourniquet group.The differences were statistically significant(P<0.05).There were no significant differences between the two groups in preoperative and postoperative 1 and 3 months values of isokinetic muscle strength(peak torque and total power)of quadriceps and hamstring muscles,KSS and VAS(P>0.05).Conclusions:The use of tourniquet during total knee arthroplasty has no significant effect on the strength of quadriceps and hamstring muscles and knee function in a short time after operation.Considering that a tourniquet can provide a better operative field of vision,the use of tourniquet during operation is still a good choice.