Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, 610041, China.
Department of Pediatrics, West China University Second Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
Int J Surg. 2018 Dec;60:182-187. doi: 10.1016/j.ijsu.2018.11.008. Epub 2018 Nov 20.
The purpose of this study was to investigate the effect of postoperative limb position on blood loss and knee function after primary total knee arthroplasty without tourniquet.
One hundred patients were randomly assigned into 2 groups: Group A was given a knee flexion position at 60° for 24 h after surgery but without the tourniquet use. Patients in group B was received the tourniquet use the same flexion position as the Group A. All patients received intravenous (IV) tranexamic acid (TXA) 15 mg/kg before skin incision and another 1 g of IV-TXA after 3 h.
The total blood loss was similar in the 2 groups. Group A had significantly less hidden blood loss and drainage volume (P = 0.023, P < 0.001), and higher intraoperative blood loss than the Group B (P < 0.001). The visual analog scale and knee circumference in Group A were lower than the Group B on postoperative days 1, 3 and 5. The range of motion was also lowering in Group A than the Group B on postoperative days 1, 3, 5 and at the 1 month. No significant differences (P > 0.05) were observed between the 2 groups regarding maximum hemoglobin drop, transfusion rate, postoperative hospital stay, DVT and/or PE, and wound-related complications.
Based on the current evidence, patients treated with postoperative limb positions without a tourniquet can effectively reduce hidden blood loss and drainage volume, as well as better early clinical benefits than those treated with a tourniquet.
Therapeutic Level I.
本研究旨在探讨初次全膝关节置换术后不使用止血带时肢体位置对失血量和膝关节功能的影响。
将 100 例患者随机分为两组：A 组术后 24 小时内膝关节保持 60°屈曲位，但不使用止血带。B 组采用与 A 组相同的膝关节屈曲位并使用止血带。所有患者均在切开皮肤前静脉（IV）给予氨甲环酸（TXA）15mg/kg，3 小时后再给予 1g IV-TXA。
两组总失血量相似。A 组隐性失血和引流量明显少于 B 组（P=0.023，P<0.001），术中失血量多于 B 组（P<0.001）。A 组术后第 1、3、5 天的视觉模拟评分和膝关节周径均低于 B 组。术后第 1、3、5 天和 1 个月，A 组的关节活动度也低于 B 组。两组最大血红蛋白下降量、输血率、术后住院时间、DVT 和/或 PE 以及与伤口相关的并发症无明显差异（P>0.05）。
根据目前的证据，与使用止血带的患者相比，术后不使用止血带的患者可以有效减少隐性失血和引流量，并具有更好的早期临床获益。
治疗水平 I。
