人工全膝关节置换中是否应用气囊止血带止血:一项Meta分析

摘要

BACKGROUND: Pneumatic tourniquet can reduce the amount of bleeding during operation, but simultaneously, pneumatic tourniquet will bring perioperative adverse reactions. It is still controversial whether to use a pneumatic tourniquet during total knee arthroplasty. OBJECTIVE: To evaluate the effect and safety of pneumatic tourniquet in total knee arthroplasty. METHODS: We searched PUBMED, EMBASE, the Cochrane Library, CNKI, Wanfang before July 2017 for randomized controlled trials regarding the effect of pneumatic tourniquet in total knee arthroplasty. Data were extracted and analyzed by using Revman 5.3 software.RESULTS AND CONCLUSION: Totally 18 studies were included. Meta-analysis suggested that the use of pneumatic tourniquet could reduce the total amount of blood loss in the total knee arthroplasty, shorten operation time, but could increase postoperative pain and thrombosis incidence (P < 0.05). There was no statistically significant difference in HSS score and range of motion of the knee at 7 days after operation (P > 0.05). These results confirm that the use of a pneumatic tourniquet in total knee arthroplasty can reduce the total blood loss, shorten the operation time, but have no effect on knee function 7 days after total knee arthroplasty, but will increase postoperative pain and thrombosis incidence.%背景:气囊止血带可以减少术中出血量,但同时会带来围手术期不良反应,目前人工全膝关节置换中是否使用气囊止血带仍有争议.目的:评价气囊止血带在人工全膝关节置换中的应用效果及安全性.方法:检索2017年7月以前PUBMED,EMBASE,Cochrane Library,CNKI,万方数据库中,检索词为"人工全膝关节置换术、气囊止血带",查找及筛选有关人工全膝关节置换中是否应用止血带技术的随机对照试验,结果采用RevMan 5.3软件进行数据提取及分析.结果与结论:共纳入18篇文献,Meta分析结果表明,使用气囊止血带可以减少人工膝关节置换中总出血量,可缩短手术时间,但是会增加术后疼痛及血栓发生率(P < 0.05).使用气囊止血带对术后7 d的HSS评分及膝关节活动度无显著性影响(P > 0.05).结果说明,人工全膝关节置换中使用气囊止血带可减少总出血量,缩短手术时间,对膝关节置换后7 d的膝关节功能无影响,但是会增加术后疼痛和血栓发生率.