止血带在全膝关节置换术中的应用效果：一项随机对照试验。
The effects of tourniquet use in total knee arthroplasty: a randomized, controlled trial.
机构信息
Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Xizhimen South Street No. 11, Beijing, China.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2017 Sep;25(9):2849-2857. doi: 10.1007/s00167-015-3964-2. Epub 2016 Jan 8.
PURPOSE
Tourniquets are still widely used in total knee arthroplasty (TKA), although they may be associated with several adverse effects. An observer-blinded, randomized, controlled trial was performed to evaluate the effects of tourniquet use in TKA.
METHODS
Fifty participants who underwent staged bilateral TKA were recruited for this study. The first-side TKA was randomly allocated to either long-duration tourniquet use or short-duration tourniquet use followed by a 3-month washout period and crossover to the other tourniquet strategy for the opposite-side TKA. Blood loss was monitored perioperatively. The operating time, allogeneic blood transfusion rate, thigh pain, knee pain, limb swelling, clinical outcome as measured by the Likert-type Western Ontario and McMaster University (WOMAC) score, straight leg raising and knee active range of motion (ROM) were also recorded.
RESULTS
The long-duration tourniquet group exhibited reduced total blood loss [-99.1 ml, 95 % confidence interval (CI) -168.1 to -30.1, P = 0.0411] and intraoperative blood loss (-225.2 ml, 95 % CI -369.5 to -80.9, P = 0.0071) compared with the short-duration tourniquet group. However, there were greater postoperative blood loss (69.6 ml, 95 % CI 21.1 to 118.2, P = 0.0282) and hidden blood loss (52.8 ml, 95 % CI 10.5 to 95.1, P = 0.0332) in the long-duration tourniquet group. The short-duration tourniquet group showed better outcomes for thigh and knee pain, limb swelling, WOMAC score at 6-week follow-up, straight leg raising and knee ROM. Similar allogeneic blood transfusion rates were observed for both groups.
CONCLUSION
Total and intraoperative blood losses were reduced with the long-duration tourniquet use, whereas the short-duration tourniquet use would reduce postoperative and hidden blood losses without increasing the allogeneic blood transfusion rate. In addition, short-duration tourniquet use would result in faster recovery and less pain during the early rehabilitation period following TKA.
LEVEL OF EVIDENCE
I.
目的
尽管止血带可能会引起一些不良反应，但在全膝关节置换术（TKA）中仍广泛使用。本研究旨在评估使用止血带对 TKA 的影响，采用盲法、随机、对照试验。
方法
本研究纳入了 50 名接受分期双侧 TKA 的患者。首先对一侧 TKA 进行随机分组，分别采用长时间止血带或短时间止血带，然后在 3 个月的洗脱期后交叉至另一侧 TKA 使用另一种止血带策略。术中监测失血量。记录手术时间、异体输血率、大腿疼痛、膝关节疼痛、肢体肿胀、采用 Likert 型 Western Ontario 和 McMaster 大学（WOMAC）评分评估的临床结果、直腿抬高和膝关节主动活动度（ROM）。
结果
与短时间止血带组相比，长时间止血带组总失血量减少[-99.1ml，95%置信区间（CI）-168.1 至-30.1，P=0.0411]和术中失血量减少[-225.2ml，95%CI-369.5 至-80.9，P=0.0071]。然而，长时间止血带组术后失血量更多（69.6ml，95%CI 21.1 至 118.2，P=0.0282）和隐性失血量更多（52.8ml，95%CI 10.5 至 95.1，P=0.0332）。短时间止血带组大腿和膝关节疼痛、肢体肿胀、6 周随访时 WOMAC 评分、直腿抬高和膝关节 ROM 结果更好。两组异体输血率相似。
结论
长时间止血带使用可减少总失血量和术中失血量，而短时间止血带使用可减少术后和隐性失血量，而不会增加异体输血率。此外，在 TKA 后的早期康复期间，短时间止血带使用可导致更快的恢复和更少的疼痛。
证据水平
I。
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