摘要
[目的]探讨全膝关节置换术(TKA)中降低止血带压力是否会减少周围组织缺血再灌注损伤,从而降低患者术后股四头肌疼痛和肿胀程度的发生。[方法]2011年5月～2012年10月,在新疆医科大学第一附属医院关节外科行初次、单侧TKA的膝关节骨性关节炎患者83例,采用随机数字表法将84例患者随机分为3组,A组:采用止血带压力为260 mmHg(1 mmHg=0.133 kPa),共25例,平均年龄69.44岁;B组:采用止血带压力为280 mmHg,共30例,平均年龄69.53岁;C组:采用止血带压力为300 mmHg,共28例,平均年龄68.96岁。对三组患者术前资料经行统计学比较,表1所示,差异均无统计学意义(P>0.05)。对三组患者术后3 d的股四头肌肿胀率、疼痛视觉模拟评分(VAS)经行记录,方差分析。[结果]三组患者术后第3dVAS疼痛评分:A组患者术后止血带处疼痛明显小于B、C组患者(P<0.05,差异具有统计学意义);B组患者和C组患者术后疼痛评分相近,两组患者术后疼痛程度相似,(P>0.05,无明显差异)。患肢股四头肌肿胀程度:A组患者术后的股四头肌肿胀较术前的肿胀程度明显小于B、C两组患者(P<0.05,差异具有统计学意义),而B、C两组之间术后股四头肌肿胀程度没有明显的区别(P>0.05,差异无统计学意义)。[结论]TKA手术中止血带可引起组织缺血再灌注损伤,但盲目降低术中止血带的压力并不能减少组织损伤程度,进而减少各项不良并发症的发生。
[ Objective] To explore whether change pressure of tourniquet in total knee arthroplasty （TKA） will adverse risks of ischemia - reperfusion injury , pain and swelling. [ Methods ] Eighty - three undergoing primary TKA between Mary 1911 and October 2012 were randomly divided into 3 equal groups. The pressure of tourniquet was used with 260 mmHg in group A , there were 25 patients , average age was 69.44. The pressure of tourniquet was used with 280 mmHg in group B , there were 30 patients , average age was 69.53. The pressure of tourniquet was used with 300 mmHg in group C , there were 28 pa- tients , average age was 68.96. There were no statistically significant difference among the 3 groups in demographic characteris- tics before surgery. Severity of postoperative swelling , pain scores by visual analogue scale （ VAS ） were recorded and com- pared. [ Results ] Swelling of the quadriceps at 3 days after surgery were all significantly more severe in group A than in group B and group C （ P 〈 0. 05 ）, but not different between group B and C. （ P 〉 0. 05 ） . The VAS pain scores of the quadriceps at 3 days after surgery were all significantly more severe in group A than in group B and group C （ P 〈 O. 05 ） , but no different be- tween group B and C. （ P 〉 0. 05 ） . [ Conclusion ] TKA using tourniquet can make risks of ischemia - reperfusion injury But reducing the tourniquet pressure does not reduce the risk of tissue damage degree, and then reduce the adverse complica- tions.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第13期1297-1301,共5页
Orthopedic Journal of China
关键词
全膝关节置换术(TKA)
止血带
压力
缺血再灌注损伤
术后并发症
total knee arthroplasty （ TKA）, tourniquet, pressure, ischemia - reperfusion injury, postopera- tive complications
