Department of Joint Surgery and Sports Medicine, Changzheng Hospital, Naval Medical University, 415#, Fengyang Road, Huangpu District, Shanghai, 200003, China.
Department of Orthopaedic Surgery, Nantong Hospital Affiliated to Shanghai University (Nantong Sixth People's Hospital), 500#, Yonghe Road, Chongchuan District, Nantong, Jiangsu Province, 226011, China.
Sci Rep. 2022 Jun 10;12(1):9652. doi: 10.1038/s41598-022-13672-6.
Tourniquet use always carries potential risks, which can range from mild transient functional impairments of thigh pain, skin blisters to severe permanent dysfunction of limb paralysis, nerve injuries or compartment syndrome. The ideal method for minimizing intraoperative tourniquet pressure (TP) for reducing postoperative complications remains controversial. In this prospective, randomized and controlled study, we reinvestigated an estimation formula for TP based on thigh circumferences and systolic blood pressure (SBP) with two traditional methods for TP determination in total knee arthroplasty (TKA): SBP plus 100 mmHg and a fixed value of 300 mmHg. TP values and postoperative thigh pain scores were compared among three groups. The intraoperative TP value of the formula-calculated group was lower than that of the traditional groups (14.7 mmHg, P = 0.3475 and 94.7 mmHg, P < 0.0001, respectively), while no differences of hemostatic effect at the surgical fields and wound complications were detected among groups. The thigh pain scores at the tourniquet site decreased gradually over time and the estimation group had the lowest scores at each timepoint after surgery. Estimation method for TP was easy and rapid, without relying on specific equipment. It could provide a practical low TP and comparable hemostatic effect in TKA using an inflating tourniquet.
止血带的使用总是存在潜在风险，范围从轻度的暂时性大腿疼痛、皮肤水疱，到严重的永久性肢体瘫痪、神经损伤或筋膜室综合征。为了最大程度地减少术后并发症，术中止血带压力（TP）的最小化的理想方法仍存在争议。在这项前瞻性、随机对照研究中，我们重新研究了一种基于大腿周长和收缩压（SBP）的 TP 估算公式，该公式结合了两种传统的全膝关节置换术（TKA）TP 确定方法：SBP 加 100mmHg 和 300mmHg 的固定值。比较了三组患者的 TP 值和术后大腿疼痛评分。公式计算组的术中 TP 值低于传统组（分别为 14.7mmHg，P=0.3475 和 94.7mmHg，P<0.0001），而手术野止血效果和伤口并发症在各组之间没有差异。止血带部位的大腿疼痛评分随时间逐渐降低，术后各时间点的估算组评分最低。TP 估计方法简单快捷，不依赖于特定设备。在使用充气止血带的 TKA 中，它可以提供一种实用的低 TP 和相当的止血效果。
