膝关节置换术中止血带的使用：基于贝叶斯网络的疼痛、功能和血栓栓塞的荟萃分析。

Tourniquet use during knee arthroplasty: A Bayesian network meta-analysis on pain, function, and thromboembolism.

机构信息

Department of Orthopaedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.

Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England, UK.

出版信息

Surgeon. 2022 Aug;20(4):241-251. doi: 10.1016/j.surge.2021.03.004. Epub 2021 May 6.

DOI:10.1016/j.surge.2021.03.004

PMID:33967006

Abstract

BACKGROUND

The role of a tourniquet for knee arthroplasty remains controversial. The present Bayesian network meta-analysis investigated the role of various protocols for tourniquet inflation for knee arthroplasty, assessing data on pain control, clinical and functional outcomes, and the rate of deep vein thrombosis (DVT).

MATERIAL AND METHODS

The present Bayesian network meta-analysis was conducted according to the PRISMA guidelines. In March 2021, all clinical trials investigating the role of tourniquet use for knee arthroplasty were considered for inclusion. Groups were divided into those which used a tourniquet in knee arthroplasty procedures versus those which completed the procedure without tourniquet, or with varying protocols of tourniquet use. The hierarchical random-effects model analysis was adopted in all comparisons.

RESULTS

Data from 54 articles (5497 procedures) were retrieved. The absence of tourniquet group evidenced the lowest rate of DVT, and scored the lowest in the visual analogic scale (VAS) at 24-48 h, 1, 3, and 12 months follow-up. The same group evidenced the greatest gain of motion at 3-days, 1 week, 1 month, 3 months, 6 months, and 12 months follow-up, and the highest Knee Society Rating System scores at 1, 3, and 12 months follow-up. Of the outcome data assessed, the straight-leg-raise test was markedly inconsistent: therefore, no recommendations from this test can be made.

CONCLUSION

With regards to the endpoints considered in the present study, knee arthroplasties undertaken without the use of a tourniquet perform better overall.

摘要

背景

止血带在膝关节置换术中的作用仍存在争议。本贝叶斯网状meta 分析调查了各种充气止血带方案在膝关节置换术中的作用，评估了疼痛控制、临床和功能结果以及深静脉血栓形成（DVT）的发生率数据。

材料和方法

本贝叶斯网状 meta 分析根据 PRISMA 指南进行。2021 年 3 月，纳入了所有研究止血带在膝关节置换术中作用的临床试验。根据是否在膝关节置换术中使用止血带来分组，或根据止血带使用的不同方案来分组。所有比较均采用分层随机效应模型分析。

结果

共检索到 54 篇文章（5497 例手术）的数据。不使用止血带组的 DVT 发生率最低，24-48 小时、1 个月、3 个月和 12 个月随访时视觉模拟评分（VAS）最低。同一组在 3 天、1 周、1 个月、3 个月、6 个月和 12 个月随访时的活动度增加最大，1、3 和 12 个月随访时的膝关节学会评分系统（Knee Society Rating System）最高。在所评估的结果数据中，直腿抬高试验结果明显不一致：因此，不能从该试验中得出任何推荐。