摘要
背景:气压止血带可减少术区出血,为手术提供清晰的视野,但由于其具有众多副损伤,国内外学者目前对止血带的应用方式存在较大争议。目的:探究优化止血带使用方案在全膝关节置换术中的临床疗效。方法:回顾分析2016年12月至2018年6月在鹤壁市人民医院行初次单侧全膝关节置换的96例骨关节炎患者的临床资料,按照止血带使用策略分2组。其中对照组56例在截骨前使用止血带,骨水泥固定后拆除;观察组40例为仅在骨水泥固定时使用止血带。记录2组患者的手术时长、止血带使用时长、术中失血量、术后出血量、并发症发生率,评估术后3 d目测类比评分、膝关节美国特种外科医院评分、膝关节活动度、患肢肿胀情况、股四头肌力恢复情况和手术满意度,并比较2组治疗差异。结果与结论:(1)2组患者手术时间和总失血量差异无显著性意义(P> 0.05),观察组止血带使用时间明显短于对照组,差异有显著性意义(P <0.05);观察组术中失血量高于对照组,术后出血量和隐形失血量低于对照组,差异有显著性意义(P <0.05);(2)观察组患者术后目测类比评分、膝关节活动度、美国特种外科医院评分、术后患肢肿胀率、直腿抬高至45°、术后满意度均优于对照组,差异有显著性意义(P<0.05);(3)2组患者术后并发症发生率差异无显著性意义(P> 0.05);(4)结果提示,优化使用止血带可降低术后疼痛、肿胀程度和术后引流量,促进肌力和关节功能恢复,提高患者满意度,对全膝关节置换总出血量无明显影响,但可增加术中出血量。
BACKGROUND: Pneumatic tourniquet can reduce bleeding in operation area and provide clear surgical visual field. However, because of its many collateral injuries, scholars at home and abroad have more controversies on the application of tourniquet.OBJECTIVE: To investigate the clinical efficacy of optimized use of tourniquet in total knee arthroplasty.METHODS: Clinical data of 96 patients with osteoarthritis who underwent primary unilateral total knee arthroplasty at the People’s Hospital of Hebi from December 2016 to June 2018 were retrospectively analyzed. The patients were divided into two groups according to the strategy of tourniquet. The control group(n=56) was treated with tourniquet before osteotomy and removed after bone cement fixation. The observation group(n=40) used tourniquet only in bone cement fixation. The operation time, tourniquet usage time, intraoperative blood loss, postoperative blood loss, and incidence of complications were recorded. The Visual Analogue Scale score, Hospital for Special Surgery score, range of motion of the knee joint, swelling of the affected limb, quadriceps muscle strength recovery and surgical satisfaction at postoperative 3 days were evaluated and compared.RESULTS AND CONCLUSION:(1) There was no significant difference in the operation time and total blood loss between two groups(P >0.05). The tourniquet usage time in the observation group was significantly shorter than that in the control group(P < 0.05). The intraoperative blood loss in the observation group was higher than that in the control group, and the postoperative blood loss and hidden blood loss in the observation group were lower than those in the control group(P < 0.05).(2) The postoperative Visual Analogue Scale score, range of motion of the knee joint, Hospital for Special Surgery score, the swelling rate of the affected limbs, straight leg raise to 45°, and postoperative satisfaction in the observation group were significantly higher than those in the control group(P < 0. 05).(3) The incidence of pos
作者
赵俊涛
郑成胜
王博
Zhao Juntao;Zheng Chengsheng;Wang Bo(Department of Orthopedics,the People’s Hospital of Hebi,Hebi 458000,Henan Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2019年第20期3124-3129,共6页
Chinese Journal of Tissue Engineering Research
关键词
优化止血带
全膝关节置换术
出血量
疼痛
肿胀
肌力
膝关节活动度
患者满意度
optimized use of tourniquet
total knee arthroplasty
blood loss
pain
swelling
muscle strength
range of motion of the knee joint
satisfaction of patients
