Pavão Douglas M, Pires eAlbuquerque Rodrigo S, de Faria José Leonardo R, Sampaio Yuri D, de Sousa Eduardo B, Fogagnolo Fabricio
Knee Surgery Center of the National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil; University of São Paulo, Ribeirão Preto Medicine School, Brazil.
Knee Surgery Center of the National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil.
J Arthroplasty. 2023 Apr;38(4):685-690. doi: 10.1016/j.arth.2022.10.026. Epub 2022 Oct 21.
The results of recent studies investigating tourniquet (TNQ) use for knee arthroplasty are controversial. Therefore, this study aimed to compare patients undergoing total knee arthroplasty who did not have a TNQ to those in whom an optimized TNQ protocol was applied.
We prospectively evaluated 127 patients who had knee osteoarthritis who had undergone total knee arthroplasty and randomized them into two groups: "without TNQ" and "optimized TNQ" (TNQ inflation before skin incision, deflation after cementing, with pressure one hundred millimeters of mercury above the systolic blood pressure, and without articular suction drain usage). The means of surgery and TNQ duration, blood loss, number of blood transfusions, degree of pain, edema, range of motion (ROM), functional score over time, and postoperative complications were compared between the groups. Statistical significance was set at P < .05.
No significant differences were found in terms of surgical timing, blood loss, thigh and knee pain, edema, ROM, functional scores, and complications between the "without TNQ" and "optimized TNQ" groups.
The use of an optimized TNQ in primary total knee arthroplasty presents similar clinical results to surgery without a TNQ and did not increase the incidence of postoperative complications. Its use allowed surgery to occur with the benefits of a clean and dry surgical field provided by TNQ without increasing procedure-related comorbidities.
近期关于膝关节置换术中使用止血带（TNQ）的研究结果存在争议。因此，本研究旨在比较接受全膝关节置换术且未使用TNQ的患者与应用优化TNQ方案的患者。
我们前瞻性评估了127例患有膝关节骨关节炎并接受全膝关节置换术的患者，并将他们随机分为两组：“不使用TNQ组”和“优化TNQ组”（皮肤切口前充气，骨水泥固定后放气，压力比收缩压高100毫米汞柱，且不使用关节腔引流）。比较两组之间的手术时间、TNQ使用时长、失血量、输血次数、疼痛程度、水肿情况、活动范围（ROM）、随时间变化的功能评分以及术后并发症。设定P <.05为统计学显著性水平。
“不使用TNQ组”和“优化TNQ组”在手术时间、失血量、大腿和膝关节疼痛、水肿、ROM、功能评分及并发症方面均未发现显著差异。
在初次全膝关节置换术中使用优化的TNQ与不使用TNQ的手术临床结果相似，且未增加术后并发症的发生率。使用TNQ使得手术能够在其提供的清洁干燥手术视野的优势下进行，而不会增加与手术相关的合并症。
