全膝关节置换术中止血带应用对假体骨水泥厚度影响的对照研究

摘要

Objective To research the tourniquet effect on cement mantle thickness in total knee arthroplasty.Methods From June 2013 to June 2014,112 cases of patients were received total knee arthroplasty in the First People's Hospital of Foshan and 94 cases of which received primary operation,82 cases were recruited of the research and randomly divided into experimental group(n=41) without tourniquet and control group(n =41)with tourniquet.The radiological cement mantle thickness was evaluated postoperatively in 2 zones (tibia) on anteroposterior and 4 zones (tibia 2;femur 2) on lateral radiographs,and values were cumulated.Additionally,the calculated blood loss,haemoglobin loss,blood transfusion rate,average transfusion volume,VAS pain score,arc of motion,swelling,ecchymosis and micro thrombus in venules were recorded.Results The study showed that (3.57± 0.62) mm on without tourniquet group and(3.74 ±0.71)mm on tourniquet group in tibia (P=0.240).However,the cement mantle thickness of mm on without tourniquet group(2.00±0.43) mm on tourniquet group(2.19±0.48) in femur (P=0.053),there was no statistically significant difference between two groups.The tourniquet group were reduced on the calculated blood loss,haemoglobin loss,blood transfusion rate and average transfusion volume compared with without tourniquet group(P＜0.05).But VAS pain score,arc of motion,swelling,ecchymosis and micro thrombus in venules were slightly increased in tourniquet group compared with without tourniquet group (P＜0.05).Conclusion The use of a tourniquet in total knee arthroplasty can reduce the calculated blood loss,haemoglobin loss,blood transfusion rate,average transfusion volume,but without using a tourniquet has a better clinical results.%目的 探讨全膝关节置换术(TKA)中是否使用止血带对膝关节假体骨水泥厚度的影响.方法 2013年6月至2014年6月采用人工TKA治疗中重度骨性关节炎患者112例,其中94例为初次置换.按照选择标准共82例(82膝)患者纳入研究.所有患者随机分为非止血带组(41例膝)和止血带组(41例膝),止血带组术中全程使用止血带,非止血带组不使用止血带.所有患者术后行膝关节正侧位片检查,测量侧位片上股骨2个测量点,胫骨2个测量点和正位片上胫骨2个测量点假体下骨水泥厚度,同时记录分析两组的显性失血量、血红蛋白(Hb)降低值、输血率、平均输血量、视觉模拟评分法(VAS)疼痛评分、膝关节活动度、肢体肿胀、肌间静脉血栓、皮下淤斑等.结果 两组均无术后感染、伤口坏死等并发症,非止血带组在围术期显性失血量、Hb降低值、输血率、平均输血量、膝关节活动度方面比较明显高于止血带组(P＜0.05),在VAS疼痛评分、肢体肿胀、肌间静脉血栓、皮下淤斑发生率方面明显低于止血带组(P＜0.05).术后测量胫骨骨水泥厚度[非止血带组(3.57±0.62)mm,止血带组(3.74±0.71)mm)],股骨骨水泥厚度[非止血带组(2.00±0.43)mm,止血带组(2.19±0.48)mm],两组比较差异均无统计学意义(P＞0.05).结论 TKA中使用止血带可以减少显性失血量、输血率及平均输血量,但不使用止血带有更好的临床效果.