Bressi Edoardo, Longo Umile Giuseppe, Mangiacapra Fabio, Candela Vincenzo, Berton Alessandra, Salvatore Giuseppe, Capuano Marialessia, Proietti Riccardo, Denaro Vincenzo
Department of Cardiovascular Sciences, University Campus Bio-Medico of Rome, Rome, Italy.
Department of Orthopedics and Traumatology, University Campus Bio-Medico of Rome, Rome, Italy.
J Knee Surg. 2020 Aug;33(8):762-767. doi: 10.1055/s-0039-1688565. Epub 2019 May 7.
The benefits of tourniquet use during orthopaedic surgery are controversial. We aim to investigate its effects on systemic inflammation, functional physical recovery, and cardiovascular complications of patients undergoing knee arthroplasty. We enrolled 129 consecutive patients (57 treated with tourniquet vs. 72 in the control group) undergoing total unilateral knee arthroplasty, followed by inpatient rehabilitation protocol at our institution. Blood samples were drawn in all patients at baseline and within 24 hours after surgery for complete blood cell count assessment. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated as the ratio between the absolute number of neutrophil and platelets over the absolute number of lymphocytes, respectively. The numeric rating scale (NRS; 0-10) assessed the current pain, day after the surgery. All subjects underwent physical functional evaluation measured by the modified Barthel's index (MBI) at the end of the rehabilitation. We also recorded the incidence of major bleeding, typical angina, and occurrence of atrial fibrillation after surgery. In the overall population, a significant postprocedural increase in NLR and PLR was observed ( < 0.001). Baseline NLR and PLR were similar in patients with and without tourniquet (1.5 ± 0.8 vs. 1.95 ± 1.2, = 0.081; 120 ± 42 vs. 131 ± 55, = 0.240); however, patients treated with tourniquet showed significantly lower NLR at 24 hours (6.1 ± 3.6 vs. 8.1 ± 5.7, = 0.043). NRS scores were significantly higher in the tourniquet group without compromising functional and physical recovery whereas no significant differences were appreciated in MBI scores between the two groups. Moreover, the rates of postoperative atrial fibrillation (1 [2%] vs. 9 [12%], = 0.042) and major bleeding (2 [4%] vs. 11 [15%], = 0.038) were significantly lower in the tourniquet group. Tourniquet seems a useful tool which is able to mitigate the inflammatory activation and prevent the occurrence of atrial fibrillation and major bleeding without altering functional physical recovery of patients undergoing total knee arthroplasty.
骨科手术中使用止血带的益处存在争议。我们旨在研究其对接受膝关节置换术患者的全身炎症、功能恢复以及心血管并发症的影响。我们连续纳入了129例接受单侧全膝关节置换术的患者（57例使用止血带，72例为对照组），随后在我们机构按照住院康复方案进行治疗。所有患者在基线时以及术后24小时内采集血样进行全血细胞计数评估。中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）分别计算为中性粒细胞和血小板绝对数与淋巴细胞绝对数之比。数字评分量表（NRS；0 - 10）评估术后当天的当前疼痛程度。所有受试者在康复结束时通过改良巴氏指数（MBI）进行身体功能评估。我们还记录了术后大出血、典型心绞痛以及心房颤动的发生率。在总体人群中，观察到术后NLR和PLR显著升高（<0.001）。使用止血带和未使用止血带的患者基线NLR和PLR相似（1.5±0.8对1.95±1.2，P = 0.081；120±42对131±55，P = 0.240）；然而，使用止血带的患者在24小时时NLR显著更低（6.1±3.6对8.1±5.7，P = 0.043）。止血带组的NRS评分显著更高，但不影响功能和身体恢复，而两组间MBI评分无显著差异。此外，止血带组术后心房颤动发生率（1例[2%]对9例[12%]，P = 0.042）和大出血发生率（2例[4%]对11例[15%]，P = 0.038）显著更低。止血带似乎是一种有用的工具，能够减轻炎症激活，预防心房颤动和大出血的发生，同时不改变接受全膝关节置换术患者的功能恢复。
