Objective To explore the influence of different strategies application of tourniquet on perioperative blood loss, postoperative complications, visual analogue scale ( VAS) pain score and the knee function in total knee arthro-plasty ( TKA) . Methods 211 patients who underwent TKA were randomly divided into two groups. Group A com-prised of 105 patients with early tourniquet releasing for hemostasis and group B consisted of 106 patients with late tourniquet releasing after compressive dressing. Perioperative calculated total blood loss, postoperative complications, VAS score, HSS score in postoperative 7 days and 3 months and the time of acquiring 90° flexion were compared. Results The total blood loss was(945 ± 368) ml in group A and (725 ± 243) ml in group B,P value was 0. 032, which was significant. Operative time:(93. 5 ± 24. 4)min of group A was longer than (75. 0 ± 22. 1) min in group B (P<0. 001). Tourniquet time:(64. 2 ±18. 6)min and (75. 0 ±22. 1) min was in group A and B respectively,group A was shorter than group B(P=0. 004). One complication in group A and five complications in group B were detec-ted, P value was 0. 213, which was not significant. The seven days and three months for VAS postoperatively was 3. 9 ±1. 2, 2. 4 ±0. 8 for group A and 4. 5 ±1. 1, 2. 2 ±0. 9 for group B (P=0. 026 and P=0. 835,respectively). HSS score about seven days and three months, it was 85. 4 ± 8. 3, 90. 5 ± 8. 7 for group A and 78. 5 ± 7. 6, 89. 2 ± 6. 8 for group B (P=0. 015 and P=0. 815, respectively). The time for acquiring 90° flexion was(1. 5 ± 0. 6)days for group A and (2. 2 ± 0. 8)days for group B, which was significant(P=0. 042). Conclusions Releasing tourniquet be-fore wound closure increase perioperative blood loss in the TKA operation. Otherwise, it may reduce the incidence of postoperative complications, alleviate patients′pain reaction and achieve early functional rehabilitation.%目的 探讨全膝关节置换术( TKA)中止血带的不同应用方式对患者围手术期失血量、术后并发症、疼痛视觉模拟评分( VAS)以及膝关节功能恢复的影响. 方法 将211例TKA患者随机分为两组:A组105例,在切口关闭前释放止血带彻底止血;B组106例,在切口关闭弹力绷带加压包扎后释放止血带. 比较两组围手术期总失血量、术后并发症、术后7 d及3个月的VAS、HSS评分以及实现膝关节90°屈曲的时间. 结果总失血量:A组(945 ±368)ml,多于B组的(725 ±243)ml(P=0.032). 手术时间:A组(93.5 ±24.4)min,长于B组的(75. 0 ±22. 1)min(P<0. 001). 止血带时间:A组(64. 2 ±18. 6)min ,短于B组的(75. 0 ±22. 1)min (P=0. 004). 并发症:A组1例,B组5例(P=0. 213). 术后7 d及3个月的VAS:A组分别为(3. 9 ± 1. 2)分、(2. 4 ± 0. 8)分,B组分别为(4. 5 ± 1. 1)分、(2. 2 ± 0. 9)分(P=0. 026、P=0. 835). 术后7 d及3个月的膝关节HSS评分:A组分别为(85. 4 ± 8. 3)分、(90. 5 ± 8. 7)分,B组分别为(78. 5 ± 7. 6)、(89. 2 ± 6. 8)分(P=0.015、P=0.815). 术后实现膝关节90°屈曲的时间:A组为(1.5 ±0.6)d,B组为(2.2 ±0.8)d(P=0.042).结论 TKA中释放止血带会增加患者围手术期失血量,但可能会减少术后并发症的发生,减轻患者早期疼痛反应,有利于早期的功能康复.
展开▼
