不使用止血带对类风湿关节炎患者行全膝关节置换术后疼痛及功能的影响

Effects of total knee arthroplasty on postoperative pain and function of rheumatoid arthritis patients with no tourniquet

目的比较类风湿关节炎(rheumatoid arthritis,RA)患者在全膝关节置换术(total knee arthroplasty,TKA)中不使用止血带对术后疼痛及功能的影响。方法回顾分析2017年1月至2022年12月,在我院行单侧TKA的72例RA患者的临床资料,对照组全程使用止血带(36例),试验组全程不使用止血带(36例),顺利完成手术,记录患者手术时间、术中失血量、隐性失血量、总失血量,术前与术后疼痛视觉模拟评分(visual analogue scale,VAS)、活动度(range of motion,ROM)、美国特种外科医院评分表(Hospital For Special Surgery,HSS)、术后并发症等指标并进行比较。结果两组术中失血量差异无统计学意义(P>0.05)。手术时间对照组(72.5±10.0)min比试验组(78.64±14.95)min更短,差异有统计学意义(P<0.05)。隐性失血量对照组(440±167)ml较试验组(347±178)ml有所增加,术后1天总失血量对照组(510±150)ml较试验组(420±180)ml有所增加,术后7天总失血量对照组(677±205)ml较试验组(551±260)ml有所增加,差异有统计学意义(P<0.05)。术后1个月的ROM试验组(98.31±8.24)°优于对照组(91.39±6.72)°,差异有统计学意义(P<0.05)。试验组术后7天(3.02±0.88)、30天(1.50±0.66)的VAS评分均优于对照组术后7天(3.56±1.11)、30天(1.91±0.77),差异有统计学意义(P<0.05)。试验组术后7天(70.83±5.14)、30天(77.50±2.99)的HSS评分均优于对照组术后7天(68.47±3.00)、30天(74.83±1.34),差异有统计学意义(P<0.05)。两组患者均无记录的术后并发症。结论RA患者行TKA不使用止血带能减少总失血量,在疼痛、功能恢复等方面有更好的表现。

Objective To analyze the effects of total knee arthroplasty(TKA)on postoperative pain and function of rheumatoid arthritis(RA)patients with no tourniquet.Methods The clinical data of 72 RA patients who underwent unilateral TKA in our hospital from January 2017 to December 2022 were retrospectively analyzed.Tourniquet was applied throughout the operation in the control group(36 cases),while the tourniquet was not applied throughout the operation in the experimental group(36 cases).The operation time,intraoperative blood loss,hidden blood loss and total blood loss were recorded.Preoperative and postoperative visual analogue scale(VAS),range of motion(ROM),hospital for special surgery(HSS),postoperative complications and other indicators were compared.Results There was no significant difference in intraoperative blood loss between the two groups(P>0.05).The operation time of the control group(72.5±10.0)min was shorter than that of the experimental group(78.64±14.95)min,and the differences were statistically significant(P<0.05).The hidden blood loss of the control group(440±167)was higher than that of the experimental group(347±178).The total blood loss of the control group(510±150)was higher than that of the experimental group(420±180)at 1 day after operation.The total blood loss of the control group(677±205)was higher than that of the experimental group(551±260)at 7 days after operation,and the differences were statistically significant(P<0.05).The ROM of the experimental group(98.31±8.24)°was better than that of the control group(91.39±6.72)°at 1 month after operation,and the differences were statistically significant(P<0.05).The VAS scores of the experimental group at 7 days(3.02±0.88)and 30 days(1.50±0.66)were better than those of the control group at 7 days(3.56±1.11)and 30 days(1.91±0.77),and the differences were statistically significant(P<0.05).The HSS scores of the experimental group at 7 days(70.83±5.14)and 30 days(77.50±2.99)were better than those of the control group at 7 days(68.47±3.00)and 30 days(74.83±1.34),and the differences were statistically significant(P<0.05).No postoperative complications were recorded in both groups.Conclusions Non-tourniquet TKA of RA patients can reduce the total blood loss with better performance in pain and functional recovery.