止血带对全膝关节置换术后疼痛和功能的影响：系统评价和荟萃分析。
Influence of the Tourniquet on Pain and Function in Total Knee Arthroplasty: a Systematic Review and Meta-Analysis.
机构信息
Orthopaedic-Trauma Surgery Centre, University Medicine Mannheim; Medical Faculty Mannheim of the University of Heidelberg, Mannheim.
出版信息
Z Orthop Unfall. 2020 Dec;158(6):630-640. doi: 10.1055/a-0983-3808. Epub 2019 Sep 25.
BACKGROUND
The use of the tourniquet in total knee arthroplasty is still a subject of controversial discussion. Previous studies mainly focus on parameters like blood loss and operation time. The aim of this systematic review is to evaluate the postoperative outcome involving parameters such as pain intensity, analgesic consumption, knee function and complication rate with and without tourniquet use, to find a recommendation for future application in total knee arthroplasty.
MATERIAL AND METHODS
This review is based on the PRISMA Checklists. A systematic research was performed in PubMed using the key words "tourniquet", "total knee arthroplasty", "TKA" and "knee endoprosthesis" up to and including January 2018. The initial search revealed 686 Papers which were extracted by the parameters intensity of pain, analgesic consumption, function (range of motion, Hospital for Special Surgery Score, Knee Society Score) and complications (deep vein thrombosis, surgical side infection, pulmonary embolism). The program Review Manager Version 5.3 was used for statistical analysis. A significance level of p < 0,05 was defined.
RESULTS
18 studies were included in this review with 1279 total knee arthroplasties overall (646 with the use of tourniquet and 633 without). The analysis shows a significant lower pain intensity until the fifth postoperative day (p = 0,03) and also after one to three months (p = 0,04) without using the tourniquet. Range of motion is significantly higher in two to three days postoperatively (p < 0,00 001) when the surgery was performed without tourniquet. Knee Society Score shows no difference between the two groups. A deep vein thrombosis appears significantly more often when using a tourniquet (p = 0,04). There was no higher occurrence in pulmonary embolism and surgical side infections.
CONCLUSION
The use of a pneumatic tourniquet in total knee arthroplasty affects especially the early postoperative pain and functional recovery.
背景
止血带在全膝关节置换术中的使用仍然是一个有争议的话题。先前的研究主要集中在失血量和手术时间等参数上。本系统评价的目的是评估使用和不使用止血带的术后结果，包括疼痛强度、镇痛药物消耗、膝关节功能和并发症发生率等参数，为全膝关节置换术的未来应用提供建议。
材料和方法
本综述基于 PRISMA 清单。在 PubMed 中使用“止血带”、“全膝关节置换术”、“TKA”和“膝关节假体”等关键词进行系统检索，检索时间截至 2018 年 1 月。最初的搜索显示有 686 篇论文，根据疼痛强度、镇痛药物消耗、功能（活动范围、特殊外科医院评分、膝关节协会评分）和并发症（深静脉血栓形成、手术部位感染、肺栓塞）等参数进行提取。使用 Review Manager Version 5.3 进行统计分析。定义显著性水平 p<0.05。
结果
本综述共纳入 18 项研究，共 1279 例全膝关节置换术（使用止血带 646 例，不使用止血带 633 例）。分析显示，不使用止血带时，术后第 5 天（p=0.03）和 1-3 个月（p=0.04）疼痛强度显著降低。术后 2-3 天，不使用止血带时膝关节活动度显著增加（p<0.00001）。膝关节协会评分两组之间无差异。使用止血带时深静脉血栓形成的发生率显著增加（p=0.04）。肺栓塞和手术部位感染的发生率没有增加。
结论
在全膝关节置换术中使用气动止血带尤其会影响术后早期疼痛和功能恢复。
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