Rafaqat Wardah, Kumar Sudhesh, Ahmad Tashfeen, Qarnain Zul, Khan Khalid Saeed, Lakdawala Riaz Hussain
Aga Khan University, Stadium Road, Karachi, Sindh, 74800, Pakistan.
Department of Surgery, Aga Khan University, Stadium Road, Karachi, Sindh, 74800, Pakistan.
J Exp Orthop. 2022 May 12;9(1):42. doi: 10.1186/s40634-022-00471-1.
A tourniquet is routinely used during total knee arthroplasty (TKA) to reduce intra-operative hemorrhage, though surgery without a tourniquet is becoming popular. To address concerns about the effect of blood at cement interfaces on long-term implant stability, we conducted a systematic review among patients undergoing total knee arthroplasty to determine if TKA with a tourniquet, compared to TKA without a tourniquet or with reduced tourniquet duration, is associated with better mid-term and long-term implant stability.
A literature search was conducted without language restriction in PubMed, Cochrane database and Web of Science from conception to 17th March, 2021. Prospective cohorts, randomized and observational, that compared tourniquet use with a control group, followed patients for 3 months or more and reported outcomes concerning implant stability, limb function, pain and inflammation. Article selection, quality assessment according to the Revised Cochrane risk assessment scale and Newcastle Ottawa Scale, and data extraction were conducted in duplicate.
CRD42020179020.
The search yielded 4868 articles, from which 16 randomized controlled trials (RCT) and four prospective cohort studies, evaluating outcomes of 1884 knees, were included. Eleven RCTs were evaluated to be low overall risk of bias, five RCTs had some concerns and four cohort studies were good quality. Few studies showed benefits of tourniquet use in mid-term implant stability (1/6), pain (1/11) and limb inflammation (1/5), and long-term implant stability (1/1). One study reported a significantly improved range of motion (1/14) while another reported significantly reduced quadriceps strength (1/6) in the tourniquet group. The remaining studies reported non-significant effect of tourniquet use.
Although few studies indicated benefits of tourniquet use in mid-term pain, limb inflammation, implant loosening and function, and long-term implant loosening, the majority of studies report no significant advantage of tourniquet use in total knee arthroplasty.
全膝关节置换术（TKA）中常规使用止血带以减少术中出血，不过不使用止血带的手术正逐渐流行起来。为了解决关于骨水泥界面处血液对植入物长期稳定性影响的担忧，我们对接受全膝关节置换术的患者进行了一项系统评价，以确定与不使用止血带或缩短止血带使用时间的全膝关节置换术相比，使用止血带的全膝关节置换术是否与更好的中期和长期植入物稳定性相关。
在PubMed、Cochrane数据库和Web of Science中进行了从建库至2021年3月17日的无语言限制的文献检索。比较使用止血带与对照组的前瞻性队列研究、随机对照研究和观察性研究，对患者进行3个月或更长时间的随访，并报告有关植入物稳定性、肢体功能、疼痛和炎症的结果。文章筛选、根据修订的Cochrane风险评估量表和纽卡斯尔渥太华量表进行质量评估以及数据提取均进行了两次。
国际前瞻性系统评价注册库（PROSPERO）注册号：CRD42020179020。
检索得到4868篇文章，其中纳入了16项随机对照试验（RCT）和4项前瞻性队列研究，评估了1884个膝关节的结果。11项RCT被评估为总体偏倚风险较低，5项RCT存在一些问题，4项队列研究质量良好。很少有研究显示使用止血带在中期植入物稳定性（1/6）、疼痛（1/11）和肢体炎症（1/5）以及长期植入物稳定性（1/1）方面有好处。一项研究报告使用止血带组的活动范围有显著改善（1/14），而另一项研究报告该组股四头肌力量显著降低（1/6）。其余研究报告使用止血带无显著效果。
尽管很少有研究表明使用止血带在中期疼痛、肢体炎症、植入物松动和功能以及长期植入物松动方面有好处，但大多数研究报告在全膝关节置换术中使用止血带并无显著优势。
