2022 年第 11 期 第 17 卷

不同时段使用止血带对全膝关节置换术患者失血量及术后康复的影响

Effects of tourniquet use in different periods on blood loss and postoperative rehabilitation of patients undergoing total knee arthroplasty

作者：丁超1马成才1唐成2张琪琪1

英文作者：Ding Chao1 Ma Chengcai1 Tang Cheng2 Zhang Qiqi1

单位：1安徽省亳州市人民医院骨科，亳州236800；2南京医科大学附属南京医院南京市第一医院骨科，南京210006

英文单位：1Department of Orthopedics the People′s Hospital of Bozhou Anhui Province Bozhou 236800 China; 2Department of Orthopaedics Nanjing First Hospital Nanjing Medical University Nanjing First Hospital Nanjing 210006 China

关键词：全膝关节置换术；止血带；不同时段；疗效评价

英文关键词：Totalkneearthroplasty;Tourniquet;Differentperiods;Efficacyevaluation

• 摘要：

• 目的 探讨不同时段使用止血带对全膝关节置换术（TKA）患者失血量和术后康复的影响。方法 选取2019年3月至2020年6月于安徽省亳州市人民医院住院拟行TKA手术的90例患者为研究对象。完全随机分为全程组、半程组和中间组，各30例。全程组手术全程使用止血带；半程组手术开始到假体安装完毕时段使用止血带；中间组截骨完成到假体安装完毕时段使用止血带。比较3组患者手术时间、术中出血量、术后引流量、隐性失血量和总失血量，观察术后膝关节活动度和膝关节功能恢复情况，观察术后并发症发生情况。结果 3组手术时间差异无统计学意义（P>0.05）。中间组术中出血量大于、术后引流量小于全程组和半程组，隐性失血量小于全程组，差异均有统计学意义（P<0.01或P<0.05）。术后3、14、30、90 d，中间组膝关节活动度、美国特种外科医院膝关节评分明显大于全程组和半程组，差异均有统计学意义（P<0.01或P<0.05）。中间组术后3 d大腿周径、肿胀率小于全程组和半程组，差异均有统计学意义（均P<0.01）。中间组术后并发症发生率低于全程组和半程组［0（0/30）比23.3%（7/30）、6.7%（2/30）］，差异均有统计学意义（均P<0.05）。结论 安装骨水泥型假体时段有限使用止血带能减少术后出血、减轻下肢软组织损伤、促进膝关节功能恢复，同时减少膝关节置换后的并发症发生率。

• Objective To explore the effect of tourniquet use in different periods on blood loss and postoperative rehabilitation of patients undergoing total knee arthroplasty (TKA). Methods Totally 90 patients who were admitted to the People′s Hospital of Bozhou, Anhui Province from March 2019 to June 2020 and planned to undergo TKA were selected as the research objects. They were randomly divided into full course group, half course group and intermediate group, with 30 cases in each group. Tourniquet was used throughout the operation in full course group, was used from the beginning of the surgery to the completion of the prosthesis installation in half course group, and was used from the osteotomy complete to the end of prosthesis installation in intermediate group. The operation time, intraoperative blood loss, postoperative drainage, invisible blood loss, and total blood loss were compared among the three groups. The postoperative knee joint range of motion, knee function recovery, and the postoperative complications were observed. Results There was no statistically significant difference in operation time among the three groups(P>0.05). The intraoperative blood loss in the intermediate group was more and postoperative drainage was less than that in the full course group and half course group, and the invisible blood loss in the intermediate group was less than that in the full course group (P<0.01 or P<0.05). On 3, 14, 30 and 90 d after operation, knee range of motion and hospital for special surgery knee score in the intermediate group were significantly higher than those in the full course group and half course group (P<0.01 or P<0.05). The thigh circumference 3 d after operation and swelling rate in the intermediate group were less than those in the full course group and half course group (all P<0.01). The incidence of postoperative complications in the intermediate group was lower than that in the full course group and half course group［0(0/30) vs 23.3%(7/30), 6.7%(2/30)］(both P<0.05). Conclusion The appropriate use of tourniquet during the installation of bone cement prosthesis can reduce postoperative bleeding, reduce the soft tissue injury of the lower limbs, promote recovery of knee joint function, and reduce the incidence of complications after knee replacement.