Kuo Liang-Tseng, Yu Pei-An, Chen Chi-Lung, Hsu Wei-Hsiu, Chi Ching-Chi
Department of Orthopedic Surgery, Division of Sports Medicine, Chang Gung Memorial Hospital, 6, Sec West, Chia-Pu Rd, Puzih, Chiayi, 61363, Taiwan.
Centre for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
BMC Musculoskelet Disord. 2017 Aug 22;18(1):358. doi: 10.1186/s12891-017-1722-y.
To assess the effects of tourniquet use in arthroscopic anterior cruciate ligament (ACL) reconstruction surgery.
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) that compared surgical outcomes following tourniquet use against non-tourniquet use during ACL reconstruction surgery. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE for relevant RCTs. We used the Cochrane Collaboration's tool to assess the risk of bias of included RCTs, and performed a random-effects meta-analysis in calculating the pooled risk estimates. The primary outcomes was postoperative pain measured by visual analogue scale, verbal rating scale, or required morphine dose. The secondary outcomes were blood loss in drainage, operative time, muscle strength, and calf and thigh girth.
We included 5 RCTs with 226 participants (116 in the tourniquet group and 110 in the non-tourniquet group). Postoperative pain and morphine doses were not significantly different between the two groups. Compared to the non-tourniquet group, the tourniquet group had a significantly increased blood loss in the drain (mean difference: 94.40 ml; 95% CI 3.65-185.14; P = 0.04). No significant differences in the operative time and muscle strength were found between the two groups. Tourniquet use was associated with a greater decrease in thigh girth but not in calf girth.
The current evidence shows that compared to tourniquet use, ACL reconstruction surgery without tourniquet does not appear to have any major disadvantages and does not prolong operation time. There might be less drain blood loss associated with tourniquet use, though drains are no longer routinely used in ACL reconstruction surgery.
评估在关节镜下前交叉韧带（ACL）重建手术中使用止血带的效果。
我们对随机对照试验（RCT）进行了系统评价和荟萃分析，比较了ACL重建手术中使用止血带与不使用止血带后的手术结果。我们在Cochrane对照试验中央注册库、MEDLINE和EMBASE中检索了相关的RCT。我们使用Cochrane协作网的工具评估纳入的RCT的偏倚风险，并在计算合并风险估计值时进行随机效应荟萃分析。主要结局是通过视觉模拟量表、语言评定量表或所需吗啡剂量测量的术后疼痛。次要结局是引流中的失血量、手术时间、肌肉力量以及小腿和大腿围度。
我们纳入了5项RCT，共226名参与者（止血带组116名，非止血带组110名）。两组术后疼痛和吗啡剂量无显著差异。与非止血带组相比，止血带组引流中的失血量显著增加（平均差异：94.40 ml；95% CI 3.65 - 185.14；P = 0.04）。两组在手术时间和肌肉力量方面未发现显著差异。使用止血带与大腿围度的更大减小相关，但与小腿围度无关。
目前的证据表明，与使用止血带相比，不使用止血带的ACL重建手术似乎没有任何重大缺点，也不会延长手术时间。使用止血带可能会减少引流失血量，不过在ACL重建手术中引流已不再常规使用。
