Department of Orthopedics, Nyköping Hospital, 611 85, Nyköping, Sweden.
Centre for Clinical Research Sörmland, Uppsala University, Kungsgatan 41, 631 88, Eskilstuna, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2019 Apr;27(4):1035-1042. doi: 10.1007/s00167-018-5196-8. Epub 2018 Oct 17.
When a tourniquet is used during surgery on the extremities, the pressure applied to the muscles, nerves and blood vessels can cause neuromuscular damage that contributes to postoperative weakness. The hypothesis was that the rehabilitation-related results would be improved if total knee arthroplasty (TKA) is performed without the use of a tourniquet.
81 patients with osteoarthritis of the knee who underwent TKA surgery were randomized to surgery with or without tourniquet. Active flexion and extension of the knee, pain by visual analog scale (VAS), swelling by knee circumference, quadriceps function by straight leg raise, and timed up and go (TUG) test results were measured before and up to 3 months after surgery.
ANCOVA revealed no between-groups effect for flexion of the knee at day 3 postsurgery. Compared with the tourniquet group, the nontourniquet group experienced elevated pain at 24 h, with a mean difference of 16.6 mm, p = 0.005. The effect on mobility (TUG test) at 3 months was better in the nontourniquet group, with a mean difference of -1.1 s, p = 0.029.
The hypothesis that the rehabilitation-related results would be improved without a tourniquet is not supported by the results. When the results in this study for surgery performed with and without tourniquet are compared, no clear benefit for either procedure was observed, as the more pain exhibited by the nontourniquet group was only evident for a short period and the improved mobility in this group was not at a clinically relevant level.
Inconsistent results, Level II.
在四肢手术中使用止血带时，施加在肌肉、神经和血管上的压力会导致神经肌肉损伤，从而导致术后虚弱。假设如果在不使用止血带的情况下进行全膝关节置换术 (TKA)，则与康复相关的结果会得到改善。
81 例膝关节骨关节炎患者随机分为使用止血带和不使用止血带的 TKA 手术组。测量术前和术后 3 个月内膝关节主动屈伸、视觉模拟量表 (VAS) 疼痛、膝关节周径肿胀、直腿抬高股四头肌功能和计时起立行走 (TUG) 测试结果。
术后第 3 天，ANCOVA 未显示组间膝关节屈伸的差异。与止血带组相比，无止血带组在 24 小时时疼痛增加，平均差异为 16.6 毫米，p=0.005。3 个月时无止血带组的移动能力（TUG 测试）更好，平均差异为-1.1 秒，p=0.029。
不使用止血带会改善康复相关结果的假设没有得到结果的支持。当比较使用和不使用止血带进行手术的研究结果时，两种方法都没有明显的优势，因为无止血带组的疼痛仅在短时间内更为明显，而该组移动能力的改善并没有达到临床相关水平。
结果不一致，II 级。
