Academic Clinical Fellow Specialty Trainee in Trauma and Orthopaedic Surgery, Warwick Medical School & University Hospital Coventry & Warwickshire, Coventry, UK.
Consultant Orthopaedic Trauma Surgeon, Reader in Orthopaedic Surgery, St George's University Hospital NHS Foundation Trust, St George's University of London, London, UK.
Eur J Orthop Surg Traumatol. 2021 Jul;31(5):967-979. doi: 10.1007/s00590-021-02957-7. Epub 2021 Apr 1.
Tourniquet use in lower limb fracture surgery may reduce intra-operative bleeding, improve surgical field of view and reduce length of procedure. However, tourniquets may result in pain and the production of harmful metabolites cause complications or affect functional outcomes. This systematic review aimed to compare outcomes following lower limb fracture surgery performed with or without tourniquet.
We searched databases for RCTs comparing lower limb fracture surgery performed with versus without tourniquet reporting on outcomes pain, physical function, health-related quality of life, complications, cognitive function, blood loss, length of stay, length of procedure, swelling, time to union, surgical field of view, volume of anaesthetic agent, biochemical markers of inflammation and injury, and electrolyte and acid-base balance. Random-effects meta-analysis was performed. PROSPERO ID CRD42020209310.
Six RCTs enabled inclusion of 552 procedures. Pooled analysis demonstrated that tourniquet use reduced length of procedure by 6 minutes (95% CI -10.12 to -1.87; p < 0.010). We were unable to exclude increased harms from tourniquet use. Pooled analysis showed post-operative pain score was higher in tourniquet group by 12.88 on 100-point scale (95% CI -1.25-27.02; p = 0.070). Risk differences for wound infection, deep venous thrombosis and re-operation were 0.06 (95% CI -0.00-0.12; p = 0.070), 0.05 (95% CI -0.02-0.11; p = 0.150) and 0.03 (95% CI -0.03-0.09; p = 0.340).
Tourniquet use was associated with a reduced length of procedure. It is possible that tourniquets also increase incidence of important complications, but the data are too sparse to draw firm conclusions. Methodological weaknesses of the included RCTs prevent any solid conclusions being drawn for outcomes investigated. Further studies are required to address these limitations.
在下肢骨折手术中使用止血带可能会减少术中出血，改善手术视野并缩短手术时间。但是，止血带可能会引起疼痛，并产生有害代谢产物，从而导致并发症或影响功能结果。本系统评价旨在比较使用和不使用止血带进行下肢骨折手术后的结果。
我们在数据库中搜索了比较使用和不使用止血带进行下肢骨折手术的 RCT，并报告了疼痛，身体功能，健康相关生活质量，并发症，认知功能，失血量，住院时间，手术时间，肿胀，愈合时间，手术视野，麻醉剂体积，炎症和损伤的生化标志物，以及电解质和酸碱平衡的结果。进行了随机效应荟萃分析。PROSPERO ID CRD42020209310。
六项 RCT 使 552 例手术得以纳入。汇总分析表明，止血带的使用使手术时间缩短了 6 分钟（95％CI-10.12 至-1.87；p <0.010）。我们无法排除止血带使用带来的更多危害。汇总分析显示，使用止血带的患者术后疼痛评分高 12.88（100 分制）（95％CI-1.25-27.02；p = 0.070）。伤口感染，深静脉血栓形成和再次手术的风险差异分别为 0.06（95％CI-0.00-0.12；p = 0.070），0.05（95％CI-0.02-0.11；p = 0.150）和 0.03（95％CI-0.03-0.09；p = 0.340）。
止血带的使用与手术时间的缩短有关。止血带可能会增加重要并发症的发生率，但数据过于稀疏，无法得出明确的结论。纳入的 RCT 方法学上的弱点阻止了对所调查结果得出任何可靠的结论。需要进一步的研究来解决这些局限性。
