止血带在导航系统下行全膝关节置换的应用时机选择:一项单中心、回顾性分析

Timing of total knee arthroplasty with tourniquet under navigation system:a single-center,retrospective analysis

背景:传统全膝关节置换过程中应用止血带的时机已有明确报道,随着关节相关技术不断精进,导航系统下全膝关节置换应用止血带的时机却鲜有报道。目的:评估采用全程与半程止血带对Brainlab导航系统下行全膝关节置换疗效的影响。方法:回顾性分析2022年1-12月在河北省沧州中西医结合医院行导航系统下全膝关节置换患者的资料,选择符合条件的145例患者进行分析,按松开止血带时机分为全程组(n=71)和半程组(n=74)。收集患者一般资料、围术期情况、术后膝关节周围肿胀情况、下肢深静脉血栓发生情况、目测类比评分、美国特种外科医院膝关节评分和关节遗忘评分,评估膝关节功能并进行比较。结果与结论:①与半程组相比,全程组患者的手术时间更短、下肢深静脉血栓发生率更高、术后膝关节肿胀情况更重(P<0.001,P=0.027,P<0.001),术中出血量更少(P<0.001),但隐匿性失血量更多(P<0.001),且差异有显著性意义;②术后1周时,全程组目测类比评分高于半程组,差异有显著性意义(P<0.001);③术后3个月、6个月、1年两组关节遗忘评分相比,差异均无显著性意义(P>0.05);④提示采用导航系统行全膝关节置换的患者中,半程使用止血带隐匿性失血量少、术后患肢肿胀程度及下肢深静脉血栓发生率低,膝关节功能恢复更快。

BACKGROUND:The timing of tourniquet application in traditional total knee arthroplasty has been clearly reported.With the continuous refinement of jointrelated techniques,the timing of tourniquet application in total knee arthroplasty under navigation system has rarely been reported.OBJECTIVE:To evaluate the effect of total knee arthroplasty with Brainlab navigation system using full-course and half-course tourniquets.METHODS:From January to December 2022,data of 145 eligible patients who underwent total knee arthroplasty under navigation system in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province were retrospectively analyzed and they were divided into the full course group(n=71)and the half course group(n=74)according to the timing of tourniquet release.General data,perioperative conditions,postoperative swelling around the knee joint,postoperative lower extremity deep venous thrombosis,visual analog scale score,Hospital for Special Surgery knee score,and forgotten joint score were collected to assess knee joint function and statistically compared.RESULTS AND CONCLUSION:(1)The operation time of the full course group was shorter than that of the half course group,the incidence of lower extremity deep venous thrombosis was higher,and the postoperative knee joint swelling was more severe(P<0.001,P=0.027,P<0.001).The intraoperative blood loss of the full course group was less than that of the half course group(P<0.001),and the occult blood loss of the full course group was more than that of the half course group(P<0.001),with statistically significant differences.(2)At 1 week after surgery,the visual analog scale score in the full course group was significantly higher than that in the half course group(P<0.001).(3)There was no significant difference in forgotten joint score between the two groups at 3,6 months and 1 year after surgery(P>0.05).(4)It is indicated that in patients undergoing total knee arthroplasty using a navigation system,the half-course group has less occult blood loss,lower postoperative swelling and incidence of postoperative lower extremity deep venous thrombosis,and faster recovery of knee joint function.