Bin Abd Razak Hamid Rahmatullah, Tan Hwee Chye Andrew
Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore.
Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore.
Knee. 2014 Jan;21(1):176-9. doi: 10.1016/j.knee.2013.08.008. Epub 2013 Aug 28.
There has always been controversy surrounding the use of pneumatic tourniquets in total knee arthroplasty (TKA) as they have been implicated in venous thromboembolic events (VTE). We aimed to evaluate the incidence of clinically significant VTE in Asians who underwent conventional TKA under tourniquet throughout the duration of surgery, without post-operative chemical VTE prophylaxis, but using post-operative pneumatic compression devices.
Five hundred and thirty-one patients of a single surgeon who underwent elective total knee arthroplasty were retrospectively reviewed. All patients had a tourniquet applied to the operated limb. None of the patients received chemoprophylaxis against VTE. Post-operatively, only symptomatic patients were referred for ultrasonography. The patients were then stratified according to the tourniquet time: <60, 61 to 90, 91 to 120, and >120 min. The overall incidence as well as the incidence of venous thromboembolic events for each group was then calculated.
Of the 531 patients reviewed, 3 patients suffered from deep venous thrombosis (DVT) while 1 patient developed a fatal pulmonary embolism (PE). Hence, the overall incidence of clinically significant VTE was 0.75%. The 3 patients with DVT had tourniquet time of 61 to 90 min while the patient with PE had a tourniquet time of more than 120 min.
With a low overall incidence of VTE, the use of tourniquet in Asians during conventional total knee arthroplasty appears safe when post-operative pneumatic compression devices are used instead of chemical VTE prophylaxis. However, the risk of VTE seems to increase with a tourniquet time of more than 60 min.
Therapeutic studies, level III.
在全膝关节置换术（TKA）中使用气压止血带一直存在争议，因为它们与静脉血栓栓塞事件（VTE）有关。我们旨在评估在整个手术过程中使用止血带进行传统TKA的亚洲患者中，具有临床意义的VTE的发生率，这些患者术后未进行化学VTE预防，但使用了术后气压压迫装置。
回顾性分析了一位外科医生为531例患者进行择期全膝关节置换术的情况。所有患者的手术肢体均使用了止血带。所有患者均未接受VTE化学预防。术后，仅对有症状的患者进行超声检查。然后根据止血带使用时间将患者分层：<60分钟、61至90分钟、91至120分钟和>120分钟。然后计算每组的总体发生率以及静脉血栓栓塞事件的发生率。
在531例接受评估的患者中，3例发生了深静脉血栓形成（DVT），1例发生了致命性肺栓塞（PE）。因此，具有临床意义的VTE的总体发生率为0.75%。3例DVT患者的止血带使用时间为61至90分钟，而发生PE的患者止血带使用时间超过120分钟。
VTE总体发生率较低，在传统全膝关节置换术中，亚洲人使用止血带时，若使用术后气压压迫装置而非化学VTE预防，似乎是安全的。然而，止血带使用时间超过60分钟时，VTE风险似乎会增加。
治疗性研究，III级。
