Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China.
Department of Scientific Research and Training, Division of Health Service, General Hospital of Eastern theater of People's Liberation Army, Nanjing, Jiangsu, China.
J Knee Surg. 2022 Dec;35(14):1577-1586. doi: 10.1055/s-0041-1728814. Epub 2021 May 15.
Pneumatic tourniquets are used in total knee arthroplasty (TKA) for surgical field visualization and improved cementation; however, their use is controversial. This study aimed to assess the effects of tourniquet application on faster recovery post-TKA. Our hypothesis was that inflammation and limb function would be similar with different tourniquet applications. A prospective randomized double-blinded trial assessed tourniquets effects on postoperative pain, swelling, and early outcome in TKA. In present study, 50 TKAs were enrolled in each group as follows: full course (FC), cementation through closure (CTC), and no tourniquet (NT), CTC as treatment group while FC and NT as control groups. Topical blood samples of 3 mL from the joint cavity and drainage bags were obtained at special time point. At last, all samples such as tumor necrosis factor-a (TNF-a), C-C motif chemokine ligand 2 (CCL2), pentraxin 3 (PTX3), prostaglandin E2 (PGE2), superoxide dismutase 1 (SOD1), and myoglobin (Mb) were detected by ELISA. Active and passive range of motion (ROM) values, pain score by the visual analog scale (VAS), change of thigh circumference were recorded at special time point as well. In topical blood, the change of inflammatory factors, such as TNF-a, PTX3, CCL2, PGE2, SOD1, and Mb, was lower in CTC and NT groups than in FC group ( < 0.01 and 0.05). Although VAS and ROM were comparable preoperatively in three groups ( > 0.05), the perimeter growth rate was lower, pain scores (VAS) were reduced, and ROM values were improved in CTC and NT groups compared with FC group at T4, T5, and T6 postoperatively ( < 0.01 and 0.05). Improved therapeutic outcome was observed in the CTC group, indicating patients should routinely undergo TKA with cementation through closure tourniquet application.
气动止血带用于全膝关节置换术 (TKA) 以实现手术视野可视化和改善骨水泥固定；然而，其使用存在争议。本研究旨在评估止血带应用对 TKA 后更快康复的影响。我们的假设是，不同止血带应用的炎症和肢体功能会相似。一项前瞻性随机双盲试验评估了止血带对 TKA 术后疼痛、肿胀和早期结果的影响。在本研究中，每组纳入 50 例 TKA：全程（FC）、闭合时（CTC）和不使用止血带（NT）。将 CTC 作为治疗组，FC 和 NT 作为对照组。在特定时间点从关节腔和引流袋中获得 3ml 的局部血液样本。最后，通过 ELISA 检测肿瘤坏死因子-α (TNF-α)、C 型趋化因子配体 2 (CCL2)、五聚素 3 (PTX3)、前列腺素 E2 (PGE2)、超氧化物歧化酶 1 (SOD1) 和肌红蛋白 (Mb) 等所有样本。还记录了特定时间点的主动和被动关节活动范围 (ROM) 值、视觉模拟评分 (VAS) 疼痛评分和大腿周长变化。在局部血液中，与 FC 组相比，CTC 和 NT 组的 TNF-α、PTX3、CCL2、PGE2、SOD1 和 Mb 等炎症因子的变化较低（<0.01 和 0.05）。尽管三组患者术前 VAS 和 ROM 比较差异无统计学意义（>0.05），但 T4、T5 和 T6 术后 CTC 和 NT 组的周长增长率较低，疼痛评分（VAS）降低，ROM 值改善（<0.01 和 0.05）。在 CTC 组观察到治疗效果改善，表明患者应常规进行 TKA 并使用 CTC 止血带。
