半程用止血带联合鸡尾酒对全膝关节置换术后快速康复的影响

Effects of half-way tourniquet combined with cocktail on rapid recovery after total knee replacement

目的探究半程使用止血带联合鸡尾酒对全膝关节置换(total knee arthroplasty,TKA)术后快速康复的影响。方法将初次行单侧TKA的144例骨关节炎患者按照随机数字表法分为A、B、C三组,每组48例。A组全程使用止血带,不用鸡尾酒(吗啡+罗哌卡因+复方培他米松+肾上腺素);B组:半程用(在截骨时充气,安装假体完毕后放气)止血带联合用鸡尾酒;C组:全程用止血带及鸡尾酒。术后随访至少1个月。记录并比较三组患者的手术时长、止血带使用时长、总失血量、术中失血量、住院天数、并发症发生率、手术满意度并评估不同时期VAS评分、膝关节HSS评分、膝关节活动度(ROM)、股四头肌力、大腿肿胀率。结果三组手术时长、并发症发生率、总失血量比较差异无统计学意义(P>0.05);术中失血量:B组(135.79±40.23) ml多于A组(108.45±32.56) ml、C组(106.36±35.14) ml,差异有统计学意义(P<0.05),A、C两组术中失血量差异无统计学意义(P>0.05);止血带使用时长:B组(28.86±5.68) min明显低于A组(84.53±4.32) min、C组(86.21±2.34) min,差异有统计学意义(P<0.05);住院天数:B组(9.54±1.24)天明显低于A组(10.86±1.41)天、C组(10.55±1.50)天,(P<0.05),C组住院天数低于A组,差异无统计学异意义(P>0.05)。大腿肿胀率:B组术后第1天(5.73±0.85)、第2天(5.89±0.87)、第3天(6.17±0.72)优于A组第1天(6.69±1.02)、第2天(6.97±0.91)、第3天(7.42±0.68),C组第1天(6.57±0.94)、第2天(6.72±0.97)、第3天(7.34±0.74),差异有统计学意义(P<0.05)。股四头肌肌力:A组术后第1天(45.58±6.65)、第2天(52.81±9.75)、第3天(60.33±13.42)、第10天(73.56±7.74),低于B组第1天(54.28±9.23)、第2天(65.63±9.12)、第3天(76.39±14.70)、第10天(83.98±7.34)、C组第1天(49.65±7.85)、第2天(59.98±8.17)、第3天(68.52±14.67)、第10天(81.87±6.89),差异有统计学意义(P<0.05);C组股四头肌肌力术后第1天(49.65±7.85)、第2天(59.98±8.17)、第3天(68.52±14.67),低于B组,差异有统计学意义(P<0.05)。HSS评分:A组术前(52.34±2.56)分,术后第1天(55.35±3.56)分,第3天(58.65±3.72)分,第10天(71.86±4.62)分,1个月(82.25±3.89)分低于B组术前(54.57±2.42)术后第1天(60.32±2.42)第3天(64.98±5.14)第10天(72.67±4.55) 1个月(83.84±4.37),C组术前(53.87±2.31)术后第1天(59.82±3.62)第3天(64.27±4.35)第10天(72.42±3.67) 1个月(82.47±3.51)。ROM:A组术前(86.71±6.25)术后第1天(92.57±3.68)第3天(96.39±3.95)第10天(109.94±6.28) 1个月(114.33±6.45)低于B组术前(87.36±4.38)术后第1天(95.74±7.32)第3天(103.50±5.86)第10天(110.81±5.20) 1个月(114.87±6.48),C组术前(86.51±4.59)术后第1天(94.80±5.39)第3天(102.7±4.35)第10天(109.32±4.67) 1个月(113.57±4.88)。VAS评分:A组术前(6.43±1.76)术后第1天(4.32±1.89)第2天(3.81±1.42)第3天(3.42±1.27)第10天(2.30±1.2) 1个月(1.24±0.81)高于B组术前(6.38±1.46)术后第1天(3.48±1.47)第2天(3.14±1.53)第3天(2.54±1.14)第10天(2.21±1.24) 1个月(1.23±0.50),C组术前(6.48±1.51)术后第1天(3.52±1.97)第2天(3.21±1.30)第3天(2.64±1.41)第10天(2.28±1.29) 1个月(1.27±0.75)均优于术前,且呈逐渐好转趋势,差异有统计意义(P<0.05);B、C组第1～3天HSS评分、VAS评分及ROM优于A组,差异有统计学意义(P<0.05),三组术后10天、术后1个月HSS评分、VAS评分及ROM差异无统计学意义(P>0.05)。手术满意度:B组(9.42±0.34)高于A组(8.44±1.43)、C组(8.62±1.36),差异有统计学意义(P<0.05),手术满意度A组高于C组,差异无统计学意义(P>0.05)。结论半程使用止血带联合鸡尾酒在TKA中的应用能减轻术后肢体早期疼痛及肿胀,有利股四头肌肌力恢复,能够缩短住院时间,有助于患肢功能快速康复,提高患者术后满意度。

Objective To explore effects of half-way tourniquet combined with cocktail on rapid recovery after total knee arthroplasty.Methods A total of 144 patients who underwent unilateral TKA were enrolled in the study.All were divided into three groups according to the random number table:A(n=48),B(n=48),and C(n=48).Group A:tourniquets throughout the entire procedure,no Cocktails(morphine+ropivacaine+compound was tasson+adrenaline);Group B:half-way tourniquet(inflated during osteotomy,deflated after installation of the prosthesis)and Cocktails;Group C:tourniquets and Cocktails throughout.Patients were followed up for at least1 month.Surgery duration,tourniquet use,total blood loss,intraoperative blood loss,hospital stay,complication rate,and surgical satisfaction were evaluated and compared.VAS scores,knee HSS scores,knee joint activities,ROM,quadriceps strength,thigh swelling rate were evaluated.Results There were no significant differences in the surgery duration,complication rate,and total blood loss among the three groups(P>0.05).Intraoperative blood loss:Group B(135.79±40.23)ml,more than Group A(108.45±32.56)ml and Group C(106.36±35.14)ml,the differences were statistically significant(P<0.05);the differences in blood loss between the two groups were not statistically significant(P>0.05).Duration of tourniquet use:Group B(28.86±5.68)min,significantly lower than A(84.53±4.32)min and C(86.21±2.34)min(P<0.05),the differences were statistically significant.Hospital stay:Group B(9.54±1.24)days,significantly lower than A(10.86±1.41)days and C(10.55±1.50)days(P<0.05).The hospital stay in Group C was lower than those in Group A,and the differences were not statistically significant(P>0.05).Thigh swelling rate:Group B day 1(5.73±0.85),day 2(5.89±0.87),day 3(6.17±0.72)was better than Group A day 1(6.69±1.02),day 2(6.97±0.91),day 3(7.42±0.68)and Group C day 1(6.57±0.94),day 2(6.72±0.97),day 3(7.34±0.74);the differences were statistically significant(P<0.05).Quadriceps muscle strength:Group A postoperative day 1(45.58±6.65),day 2(52.81±9.75),day 3(60.33±13.42),day 10(73.56±7.74),lower than Group B day 1(54.28±9.23),day 2(65.63±9.12),day 3(76.39±14.70),day 10(83.98±7.34),and Group C day 1(49.65±7.85),day 2(59.98±8.17),day 3(68.52±14.67),day 10(81.87±6.89);the differences were statistically significant(P<0.05);Group C quadriceps muscle strength on day 1(49.65±7.85),day 2(59.98±8.17),day 3(68.52±14.67),lower than Group B;the differences were statistically significant(P<0.05).HSS score:Group A preoperative(52.34±2.56),postoperative day 1(55.35±3.56),day 3(58.65±3.72),day 10(71.86±4.62),1 month(82.25±3.89),was lower than Group B preoperative(54.57±2.42),day 1(60.32±2.42),day 3(64.98±5.14),day 10(72.67±4.55),1 month(83.84±4.37),and Group C preoperative(53.87±2.31),day 1(59.82±3.62),day 3(64.27±4.35),day 10(72.42±3.67),1 month(82.47±3.51).ROM:Group A preoperative(86.71±6.25),day 1(92.57±3.68),day 3(96.39±3.95),day 10(109.94±6.28),1 month(114.33±6.45),was lower than Group B preoperative(87.36±4.38),day 1(95.74±7.32),day 3(103.5±5.86),day 10(110.81±5.20),1 month(114.87±6.48),and Group C preoperative(86.51±4.59),day 1(94.80±5.39),day 3(102.7±4.35),day 10(109.32±4.67),1 month(113.57±4.88).VAS score:Group A preoperative(6.43±1.76),day 1(4.32±1.89),day 2(3.81±1.42),day 3(3.42±1.27),day 10(2.30±1.20)1 month(1.24±0.81),was higher than Group B preoperative(6.38±1.46),day 1(3.48±1.47),day 2(3.14±1.53),day 3(2.54±1.14),day 10(2.21±1.24),1 month(1.23±0.50),and Group C preoperative(6.48±1.51),day 1(3.52±1.97),day 2(3.21±1.30),day 3(2.64±1.41),day 10(2.28±1.29),1 month(1.27±0.75).A gradual improvement trend was shown.Differences were statistically significant(P<0.05).HSS score,VAS score and ROM of Group B and Group C were better than Group A on day 1-3,and differences were statistically significant(P<0.05).There were no significant differences in HSS score,VAS score and ROM 10 days and 1 month postoperatively(P>0.05).Surgery satisfaction:Group B(9.42±0.34)was higher than that in A(8.44±1.43)and C(8.62±1.36)with statistically significant differences(P<0.05).Satisfaction of Group A was higher than that of Group C with no statistically significant differences(P>0.05).Conclusions Use of a half-way tourniquet combined with Cocktails in TKA can reduce the early pain and swelling of the limbs,benefit the quadriceps muscle strength recovery,shorten the hospital stay,help restore the limb function,and improve the postoperative satisfaction.