Lotke P A, Faralli V J, Orenstein E M, Ecker M L
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104.
J Bone Joint Surg Am. 1991 Aug;73(7):1037-40.
We prospectively studied the cases of 121 patients who were being operated on for insertion of a unilateral total knee prosthesis with cement, and we placed them randomly in four groups. In Group I, the tourniquet was inflated throughout the operative procedure, and we released it postoperatively after a compressive dressing had been applied; a splint was used postoperatively for three days. In Group II, the tourniquet remained inflated throughout the operation, but no splint was applied postoperatively, and continuous passive motion was started immediately in the recovery room. In Group III, the tourniquet was released intraoperatively, and hemostasis was achieved by cauterization; postoperatively, a compressive dressing was applied, and a splint was used for three days. In Group IV, the tourniquet was released intraoperatively, hemostasis was established, and then the tourniquet was reinflated; a compressive dressing was applied, and continuous passive motion was started immediately in the recovery room. Hemoglobin and hematocrit values were monitored in all patients. Blood loss in suction drainage was recorded, and the total blood loss was calculated. The results show that total knee arthroplasty is associated with major loss of blood (mean, 1518 milliliters). The calculated blood loss for Groups I, II, and III averaged 1443 milliliters, while that for Group IV averaged 1793 milliliters. Loss in suction drainage correlated with total estimated blood loss and averaged 511 milliliters. The magnitude of blood loss after total knee arthroplasty should be appreciated, and special attention should be paid to the availability of adequate fluid and blood products, preferably blood donated by the patient preoperatively.
我们前瞻性地研究了121例接受单侧全膝关节置换术并使用骨水泥固定的患者，将他们随机分为四组。第一组在整个手术过程中使用止血带，术后在应用加压敷料后松开止血带；术后使用夹板三天。第二组在整个手术过程中止血带一直充气，但术后不使用夹板，在恢复室立即开始持续被动运动。第三组在术中松开止血带，通过烧灼止血；术后应用加压敷料，使用夹板三天。第四组在术中松开止血带，止血后再充气；应用加压敷料，在恢复室立即开始持续被动运动。对所有患者监测血红蛋白和血细胞比容值。记录吸引引流中的失血量，并计算总失血量。结果显示，全膝关节置换术伴有大量失血（平均1518毫升）。第一组、第二组和第三组的计算失血量平均为1443毫升，而第四组平均为1793毫升。吸引引流中的失血量与估计的总失血量相关，平均为511毫升。应认识到全膝关节置换术后的失血量，应特别注意是否有足够的液体和血液制品，最好是患者术前自体捐献的血液。
