Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Knee Surg Sports Traumatol Arthrosc. 2020 Apr;28(4):1045-1054. doi: 10.1007/s00167-019-05646-5. Epub 2019 Aug 1.
Tourniquet use during primary total knee arthroplasty (TKA) may negatively impact the early postoperative functional recovery due to molecular effects of ischaemia. The hypothesis of the present study was that primary TKA without a tourniquet positively influences the postoperative muscle strength, functional outcome, patient satisfaction and health status.
The monocentric, randomized, controlled trial included a total of 99 patients scheduled to undergo primary TKA (ClinicalTrials.gov NCT02475603). The patients were randomly assigned to the tourniquet (n = 50) or non-tourniquet (n = 49) group after receiving a written informed consent. As primary outcome parameter, the functional outcome, patient expectation/satisfaction and the health status were assessed preoperatively, 6 weeks, 6 months postoperatively using Oxford knee score, WOMAC score, Mancuso score, EQ-5D index, EQ-VAS, anxiety score, depression score, hospital anxiety and depression scale, respectively. Additionally, a rope pulley isokinetic system (Moflex, Recotec/Bernina, Switzerland) was applied to quantify the muscle strength preoperatively, 1 week, 6 weeks and 6 months postoperatively.
No difference in any of the outcome parameters could be observed between the groups at all time points after TKA (n.s.). Also the isokinetic muscle strength of the knee joint as quantified by concentric/eccentric peak force (N), workload (J), total workload (J) and power (W) did not reveal statistically significant differences between the groups and time points. However, in both groups improved results were found with respect to the functional outcome, patient satisfaction, health status and isokinetic muscle strength up to 6 months postoperatively.
The application of the tourniquet did not affect the isokinetic muscle strength, the functional outcome, the patient satisfaction and the health status following primary TKA. However, with and without tourniquet use, the level of the knee functionality, the patient satisfaction as well as the health status improved significantly.
I.
在初次全膝关节置换术（TKA）中使用止血带可能会由于缺血的分子效应对术后早期功能恢复产生负面影响。本研究的假设是，不使用止血带进行初次 TKA 会积极影响术后肌肉力量、功能结果、患者满意度和健康状况。
这项单中心、随机、对照试验共纳入了 99 例计划接受初次 TKA 的患者（ClinicalTrials.gov NCT02475603）。患者在获得书面知情同意后，随机分为止血带组（n=50）和非止血带组（n=49）。作为主要观察指标，分别在术前、术后 6 周和 6 个月，使用牛津膝关节评分、WOMAC 评分、曼库索评分、EQ-5D 指数、EQ-VAS、焦虑评分、抑郁评分、医院焦虑和抑郁量表，评估功能结果、患者期望/满意度和健康状况。此外，还使用绳索滑轮等速系统（Moflex，Recotec/Bernina，瑞士）来量化术前、术后 1 周、6 周和 6 个月的膝关节肌肉力量。
在 TKA 后所有时间点，两组之间在任何观察指标上均未观察到差异（无统计学意义）。通过向心/离心峰力（N）、工作量（J）、总工作量（J）和功率（W）量化的膝关节等速肌肉力量，两组之间和时间点之间也未显示出统计学上的显著差异。然而，在两组中，直到术后 6 个月，在功能结果、患者满意度、健康状况和等速肌肉力量方面均发现了改善结果。
应用止血带不会影响初次 TKA 后的等速肌肉力量、功能结果、患者满意度和健康状况。然而，无论是否使用止血带，膝关节功能、患者满意度和健康状况均有显著改善。
I。
