Grigoras Mihai, Boughton Oliver, Cleary May, McKenna Paul, Rowan Fiachra E
Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, X91 ER8E Waterford, Ireland - Kilcreene Regional Orthopaedic Hospital, R95 DK07 Kilkenny, Ireland.
SICOT J. 2021;7:15. doi: 10.1051/sicotj/2021019. Epub 2021 Mar 22.
Not using a tourniquet could improve early postoperative pain, range of motion (ROM), length of stay (LOS), and thromboembolic risk in patients undergoing total knee arthroplasty (TKA). Our aim was to compare these factors, intraoperative blood loss, and gender-related outcomes in patients undergoing primary TKA with or without a tourniquet.
We performed a retrospective cohort study of 97 patients undergoing TKA with or without tourniquet from 2018 to 2020. Revisions and bilateral TKAs were excluded. Blood loss was estimated using a validated formula. Postoperative pain was tested using the visual analogue scale (VAS). ROM and quadriceps lag were assessed by a physiotherapist on a postoperative day 2 and discharge. The index of suspicion for a thromboembolic event was defined as the number of embolic-related investigations ordered in the first 6 months post-surgery. The Shapiro-Wilk test was used to assess the distribution of the data, Mann-Whitney for the continuous variables, and Fischer's test for the categorical ones.
There was a significant difference in blood loss. The non-tourniquet group lost on average 32% more blood (1291 mL vs. 878 mL, p<0.001 two-tailed). We found no difference in pain, ROM, LOS, and quadriceps lag on day 2 and at discharge. There was one thromboembolic event in the tourniquet group, but the thromboembolic index of suspicion did not differ (p=0.53). With tourniquet use, women had a significantly lower day 2 maximum flexion than men (71.56° vs. 84.67°, p=0.02). In this retrospective cohort study, the results suggest that tourniquet use is associated with lower blood loss and similar postoperative pain, range of motion, quadriceps lag, length of stay, and thromboembolic risk. There might be some differences between how men and women tolerate a tourniquet, with women having worse short-term outcomes compared to men.
在全膝关节置换术（TKA）患者中，不使用止血带可能会改善术后早期疼痛、关节活动范围（ROM）、住院时间（LOS）以及血栓栓塞风险。我们的目的是比较接受初次TKA且使用或不使用止血带患者的这些因素、术中失血量以及与性别相关的结果。
我们对2018年至2020年期间97例接受TKA且使用或不使用止血带的患者进行了一项回顾性队列研究。排除翻修手术和双侧TKA患者。使用经过验证的公式估算失血量。使用视觉模拟量表（VAS）测试术后疼痛。术后第2天和出院时由物理治疗师评估ROM和股四头肌滞后情况。血栓栓塞事件的可疑指数定义为术后前6个月内进行的与栓塞相关检查的数量。使用夏皮罗-威尔克检验评估数据分布，连续变量采用曼-惠特尼检验，分类变量采用费舍尔检验。
失血量存在显著差异。非止血带组平均失血量多32%（1291 mL对878 mL，双侧p<0.001）。我们发现在术后第2天和出院时，疼痛、ROM、LOS和股四头肌滞后情况没有差异。止血带组有1例血栓栓塞事件，但血栓栓塞可疑指数没有差异（p=0.53）。使用止血带时，女性术后第2天的最大屈曲角度明显低于男性（71.56°对84.67°，p=0.02）。在这项回顾性队列研究中，结果表明使用止血带与失血量减少以及术后疼痛、关节活动范围、股四头肌滞后情况、住院时间和血栓栓塞风险相似有关。男性和女性对止血带的耐受情况可能存在一些差异，女性的短期结果比男性更差。
