Zaidi Razi, Hasan Kamrul, Sharma Aadhar, Cullen Nicholas, Singh Dishan, Goldberg Andrew
Royal National Orthopaedic Hospital, NHS Trust, Stanmore, UK.
Foot Ankle Int. 2014 May;35(5):478-82. doi: 10.1177/1071100713518504. Epub 2013 Dec 27.
More than 10,000 ankle arthroscopy procedures are performed in the United Kingdom annually. Tourniquet use is thought to allow improved visibility and reduce operative time. However this is not without risk as it predisposes to neurovascular injury. The purpose of our study was to establish the feasibility of a subsequent larger randomized controlled trial, to test the hypothesis that tourniquet use might be unnecessary in ankle arthroscopy.
We performed a prospective nonrandomized case control study on 63 patients undergoing ankle arthroscopy to assess the feasibility of a randomized control trial comparing tourniquet versus no tourniquet. All patients had a tourniquet placed on the thigh and a standard arthroscopic technique. In 1 group (n = 31) the tourniquet was routinely inflated, whereas in a second group (n = 32) the tourniquet was not inflated. Demographic data, intraoperative fluid pressures, and visibility were recorded, as were any intraoperative or postoperative complications.
There were no significant differences between the 2 groups with respect to duration of operation, maximum intraoperative fluid pressures or visibility, and postoperative complications. In no cases where a tourniquet was not used did the surgeon need to inflate the tourniquet during the case.
Most orthopaedic surgeons continue to use a tourniquet routinely for ankle arthroscopy, presumably on the belief that a clear operative view can be achieved only with a tourniquet. The findings of our feasibility study revealed that ankle arthroscopy was possible without the use of a tourniquet. We propose a randomized clinical trial to determine the best option for patient care.
Level III, comparative series.
在英国，每年进行超过10000例踝关节镜手术。使用止血带被认为可以提高视野清晰度并缩短手术时间。然而，这并非没有风险，因为它易导致神经血管损伤。我们研究的目的是确定后续更大规模随机对照试验的可行性，以检验在踝关节镜手术中可能无需使用止血带这一假设。
我们对63例接受踝关节镜手术的患者进行了一项前瞻性非随机病例对照研究，以评估比较使用止血带与不使用止血带的随机对照试验的可行性。所有患者均在大腿上放置止血带并采用标准关节镜技术。一组（n = 31）常规充气止血带，而另一组（n = 32）不充气止血带。记录人口统计学数据、术中液体压力和视野清晰度，以及任何术中或术后并发症。
两组在手术持续时间、术中最大液体压力或视野清晰度以及术后并发症方面无显著差异。在未使用止血带的病例中，术者在手术过程中均无需充气止血带。
大多数骨科医生在踝关节镜手术中仍常规使用止血带，大概是认为只有使用止血带才能获得清晰的手术视野。我们可行性研究的结果表明，不使用止血带也可以进行踝关节镜手术。我们建议进行一项随机临床试验以确定患者护理的最佳选择。
三级，比较系列研究。
