膝关节置换术中止血带松开的时机。随机对照试验的荟萃分析。

Timing of tourniquet release in knee arthroplasty. Meta-analysis of randomized, controlled trials.

作者信息

Rama Krishna Reddi Boddu Siva, Apsingi Sunil, Poovali Sharmila, Jetti Anand

机构信息

Hammersmith Hospitals NHS Trust, London, United Kingdom.

出版信息

J Bone Joint Surg Am. 2007 Apr;89(4):699-705. doi: 10.2106/JBJS.F.00497.

DOI:10.2106/JBJS.F.00497

PMID:17403789

Abstract

BACKGROUND

Some surgeons release the tourniquet before closing the wound to secure hemostasis during knee arthroplasty. We examined whether early tourniquet release could reduce the perioperative blood loss and whether not releasing the tourniquet until after wound closure would increase the risk of early postoperative complications.

METHODS

We searched electronic databases and reference lists of relevant articles, retrieved all of the published randomized controlled trials designed to address these issues, and performed a meta-analysis.

RESULTS

Eleven studies involving a total of 872 patients and 893 primary knee arthroplasties were analyzed systematically. The studies showed considerable clinical and methodological diversity. Early release of the tourniquet increased the total measured blood loss (weighted mean difference = 228.7 mL; 95% confidence interval = 168.3 to 289.1; p < 0.00001). Early release also increased blood loss as calculated on the basis of the maximum decrease in hemoglobin concentration (weighted mean difference = 320.7 mL; 95% confidence interval = 204.3 to 437.1; p < 0.00001). The rate of reoperations due to postoperative complications was 3.1% (nine of 290) in the group with late tourniquet release compared with 0.3% (one of 290) in the group with early tourniquet release; the risk difference was 3% (95% confidence interval, 0.1% to 5%), which was significant (p = 0.04).

CONCLUSIONS

Early tourniquet release for hemostasis increases the blood loss associated with primary knee arthroplasty. However, tourniquet release after wound closure can increase the risk of early postoperative complications requiring another operation. Well-conducted large studies are needed to further explore the risk of early postoperative complications associated with late tourniquet release in knee arthroplasty.

LEVEL OF EVIDENCE

Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

摘要

背景

在膝关节置换术中，一些外科医生在关闭伤口前松开止血带以确保止血。我们研究了早期松开止血带是否能减少围手术期失血，以及直到伤口关闭后才松开止血带是否会增加术后早期并发症的风险。

方法

我们检索了电子数据库和相关文章的参考文献列表，检索了所有旨在解决这些问题的已发表随机对照试验，并进行了荟萃分析。

结果

系统分析了11项研究，共涉及872例患者和893例初次膝关节置换术。这些研究显示出相当大的临床和方法学差异。早期松开止血带增加了测量的总失血量（加权平均差=228.7 mL；95%置信区间=168.3至289.1；p<0.00001）。根据血红蛋白浓度的最大下降计算，早期松开止血带也增加了失血量（加权平均差=320.7 mL；95%置信区间=204.3至437.1；p<0.00001）。晚期松开止血带组术后并发症导致的再次手术率为3.1%（290例中有9例），而早期松开止血带组为0.3%（290例中有1例）；风险差异为3%（95%置信区间，0.1%至5%），具有显著性（p=0.04）。