| 卢庆峰,周祖忠,陈晓.高血压病人在全膝关节置换术中不同时期应用止血带的临床效果比较.骨科,2019,10(2): 95-100. |
| 高血压病人在全膝关节置换术中不同时期应用止血带的临床效果比较 |
| Clinical effects of tourniquet application in different periods of total knee arthroplasty in patients with hypertension |
| 投稿时间：2018-12-10 |
| DOI：10.3969/j.issn.1674-8573.2019.02.003 |
| 中文关键词: 骨性关节炎 高血压 止血带 关节成形术，置换，膝 |
| 英文关键词: Osteoarthritis Hypertension Tourniquet Arthroplasty, replacement, knee |
| 基金项目:国家自然科学基金（31771051） |
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| 中文摘要: |
| 目的 探讨止血带在高血压病人全膝关节置换术（total knee arthroplasty, TKA）中的使用效果，分析合并高血压的TKA病人在不同时期使用止血带对术中失血、术后失血、术后康复锻炼以及术后并发症等方面的影响。方法 2015年3月至2018年3月因膝骨关节炎于我院接受初次TKA的60例高血压病人，根据止血带使用时间的不同分为三组，其中A组20例病人在切皮前开始使用气囊止血带，缝合完毕加压包扎后松开；B组20例病人在安放水泥型膝关节假体前开始使用气囊止血带，缝合完毕加压包扎后松开；C组20例病人在安放水泥型膝关节假体前开始使用气囊止血带，骨水泥凝固后松开。分别记录3组病人术中、术后失血量，围手术期输血量。采用疼痛视觉模拟量表（visual analogue scale, VAS）评价病人疼痛情况、美国膝关节协会评分（knee society score, KSS）评价病人术后3 d、3周、1年的膝关节功能。结果 A组的术中失血量为（170.81±34.83） ml，B组为（194.95±24.96） ml，C组为（248.88±25.86） ml，差异有统计学意义（F=5.834，P=0.022）；A组总失血量为（923.56±197.79） ml，B组为（773.67±183.76） ml，C组为（827.50±182.79） ml，差异有统计学意义（F=4.733，P=0.031）。A组术后3 d肿胀率及VAS评分［9.93%±0.97%、（7.32±1.26）分］明显高于B组［6.03%±0.85%、（4.72±0.82）分］及C组［5.91%±0.73%、（4.94±0.63）分］；术后3周时，A组的KSS评分为（46.74±6.72）分，明显低于B组的［（69.72±7.93）分］、C组的［（68.83±7.86）分］；上述差异均有统计学意义（P均＜0.05）。术后1年，3组之间的KSS评分差异无统计学意义（F=2.314，P=0.834）。A组有1例发生深静脉血栓，有1例发生术后贫血，2例发生肌间静脉血栓，B组无并发症出现，C组有1例发生肌间静脉血栓。结论 安放水泥型膝关节假体前开始使用止血带，缝合完毕加压包扎后松开，可明显改善病人的术中出血量及术后近期功能效果，术后并发症少，但远期临床疗效有待进一步观察。 |
| 英文摘要: |
| Objective To investigate the effect of tourniquet on total knee arthroplasty (TKA) in patients with hypertension, and to analyze the effects of tourniquet on blood loss during and after operation, rehabilitation exercise and complications after operation in patients with hypertension undergoing TKA. Methods Total of 60 hypertensive patients with knee osteoarthritis who received TKA for the first time in our hospital from March 2015 to March 2018 were collected. According to the time of tourniquet use, they were divided into three groups. Among them, in group A (20 cases) balloon tourniquet was used before skin incision and loosened after suture and compression bandage. Twenty patients in group B began to use the balloon tourniquet before placing the cement type knee prosthesis, and after the suture was completed, the compression bandage was released. Twenty patients in group C began to use air bag tourniquet before placing cement type knee prosthesis, and the tourniquet was released after bone cement solidification. Blood loss during and after operation and perioperative blood transfusion were recorded in three groups. Visual analogue scale (VAS) was used to evaluate the pain of patients and Knee Society score (KSS) was used to evaluate the knee function of patients 3 days, 3 weeks and 1 year after operation. Results The intraoperative blood loss in groups A, B and C was (170.81±34.83) ml, (194.95±24.96) ml, and (248.88±25.86) ml respectively. The difference was statistically significant (F=5.834, P=0.022). The total blood loss in groups A, B and C was (923.56±197.79) ml, (773.67±183.76) ml, and (827.50±182.79) ml respectively. The difference was statistically significant (F=4.733, P=0.031). The swelling rate and VAS score in group A (9.93%±0.97% and 7.32±1.26) were significantly higher than those in group B (6.03%±0.85% and 4.72±0.82) and group C (5.91%±0.73% and 4.94±0.63). At 3rd week after operation, the KSS score in group A was (46.74±6.72), which was significantly lower than that in group B (69.72±7.93) and group C (68.83±7.86). There was no significant difference in KSS score among the three groups one year after operation (F=2.314, P=0.834). In group A, there were 1 case of deep venous thrombosis, 1 case of anemia after operation, and 2 cases of intermuscular venous thrombosis. No complications occurred in group B, and there was 1 case of intermuscular venous thrombosis in group C. Conclusion Tourniquet was used before cement type knee prosthesis was placed, and loosening of tourniquet after pressure dressing following suture can significantly reduce the intraoperative blood loss and improve short-term postoperative functional effect of patients, with fewer complications after operation, but the long-term clinical efficacy remains to be further observed. |
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