Lenox Hill Hospital, New York, NY, USA.
Clin Orthop Relat Res. 2014 Jan;472(1):169-74. doi: 10.1007/s11999-013-3124-2.
Total knee arthroplasty with the use of a tourniquet during the entire operation has not been shown to improve the performance of the operation and may increase the risk of complications.
QUESTIONS/PURPOSES: We asked whether the limited use of a tourniquet for cementation only would affect (1) surgical time; (2) postoperative pain and motion of the knee; (3) blood loss; or (4) complications such as risk of nerve injuries, quadriceps dysfunction, and drainage compared with use of a tourniquet throughout the procedure.
Seventy-one patients (79 knees) were randomized to either use of a tourniquet from the incision through cementation of the implants and deflated for closure (operative tourniquet group) or tourniquet use only during cementation (cementation tourniquet group). The initial study population was a minimum of 30 knees in each group as suggested for randomized studies by American Society for Testing and Materials standards; termination of the study was determined by power analysis performed after 40 knees in each group showed any statistical solution to our questions would require a minimum of 260 more cases. Patients were excluded who were considered in previous randomized studies as high risk for complications, which might be attributed to the tourniquet.
There were no differences in terms of surgical time, pain scores, pain medicine requirements, range of motion, hemoglobin change, or total blood loss. One major complication (compartmental syndrome) occurred in a patient with tourniquet inflation until closure. No other complications were attributed to the use of a tourniquet.
With the numbers available, our results suggest that there are no important clinical differences between patients who had a tourniquet inflated throughout the procedure compared with those who had it inflated only during cementation. Tourniquet inflation for cementation only provides the benefit of bloodless bone for fixation and may eliminate the risks associated with prolonged tourniquet use.
在整个手术过程中使用止血带并未显示出可以改善手术效果，反而可能增加并发症的风险。
问题/目的：我们想知道，与整个手术过程中使用止血带相比，仅在骨水泥固定时使用止血带（1）是否会影响手术时间；（2）术后膝关节疼痛和活动度；（3）出血量；或（4）神经损伤、股四头肌功能障碍和引流等并发症的风险。
71 名患者（79 个膝关节）随机分为两组：止血带从切口到植入物骨水泥固定期间充气，然后放气关闭切口（手术止血带组）或仅在骨水泥固定期间使用止血带（骨水泥止血带组）。根据美国测试与材料协会标准建议的随机研究最小样本量为每组 30 个膝关节，本研究初始病例数为每组 40 个膝关节，每组至少有 40 个膝关节的研究结果出现统计学差异，才可以进行后续研究。如果认为患者有发生与止血带相关并发症的高风险，将其排除在研究之外。
在手术时间、疼痛评分、止痛药需求、活动范围、血红蛋白变化或总失血量方面，两组均无差异。在充气直至关闭切口的患者中，有 1 例发生严重并发症（筋膜间室综合征）。没有其他并发症归因于止血带的使用。
根据现有的数据，我们的结果表明，与整个手术过程中使用止血带的患者相比，仅在骨水泥固定时使用止血带的患者没有重要的临床差异。仅在骨水泥固定时充气止血带可提供用于固定的无血骨，并可能消除与长时间使用止血带相关的风险。
