First Affiliated Hospital of Xiamen University, Xiamen City, China; College of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou City, China.
First Affiliated Hospital of Xiamen University, Xiamen City, China.
Arthroscopy. 2023 Mar;39(3):626-637.e3. doi: 10.1016/j.arthro.2022.10.033. Epub 2022 Nov 2.
To examine the effect of tourniquet use in arthroscopic anterior cruciate ligament reconstruction in terms of: (1) intraoperative visualization with operative time and consumption of sterile saline, and (2) intra- and postoperative blood loss, postoperative pain, opioid consumption, swelling, serum creatine phosphokinase (CPK) and hemoglobin (Hb) concentrations, clinical outcomes, and graft healing.
In this prospective randomized clinical trial, patients were assigned to tourniquet inflation (tourniquet-up) or tourniquet deflation (tourniquet-down) groups. Primary outcomes were intraoperative visualization with operative time and sterile saline consumption. Secondary outcomes were intra- and postoperative blood loss, postoperative pain, opioid consumption, swelling, serum CPK, Hb concentration, subjective and objective functional scores, and graft healing.
Intraoperative visualization was satisfactory in 100 of 100 cases in the tourniquet-up group and 64 of 100 cases in the tourniquet-down group (P < .05). The mean operative time was 58.4 ± 5.7 minutes in the tourniquet-up group and 72.5 ± 8.6 minutes in the tourniquet-down group (P < .05). The mean sterile saline consumption was 6.4 ± 2.5 L in the tourniquet-up group and 8.7 ± 4.6 L in the tourniquet-down group (P < .05). The respective amounts of estimated intraoperative and postoperative blood loss were 95.3 ± 25.1 mL and 240.3 ± 44.5 mL in the tourniquet-up group and 230.2 ± 22.3 mL and 75.6 ± 15.3 mL in the tourniquet-down group (P < .05). Our results showed no significant difference in postoperative pain, opioid consumption, percentage of patients using opioids, swelling, mean serum CPK and Hb levels, subjective and objective functional scores, or graft healing (P > .05) between the 2 groups.
Tourniquet use during anterior cruciate ligament reconstruction significantly improves intraoperative visualization, shortens operative time, and decreases intraoperative sterile saline consumption and blood loss without serious adverse events or greater complication rates based on early postoperative outcomes.
Level I, randomized controlled trial.
探讨关节镜下前交叉韧带重建术中使用止血带的效果，包括：（1）术中可视化效果、手术时间和无菌生理盐水的消耗，以及（2）术中及术后失血、术后疼痛、阿片类药物消耗、肿胀、血清肌酸磷酸激酶（CPK）和血红蛋白（Hb）浓度、临床结果和移植物愈合。
在这项前瞻性随机临床试验中，患者被分配到止血带充气（止血带充气组）或止血带放气（止血带放气组）组。主要结局是手术时间和无菌生理盐水消耗的术中可视化效果。次要结局是术中及术后失血、术后疼痛、阿片类药物消耗、肿胀、血清 CPK、Hb 浓度、主观和客观功能评分以及移植物愈合。
止血带充气组 100 例患者中有 100 例、止血带放气组 100 例中有 64 例术中可视化效果满意（P<.05）。止血带充气组的平均手术时间为 58.4±5.7 分钟，止血带放气组为 72.5±8.6 分钟（P<.05）。止血带充气组的平均无菌生理盐水消耗为 6.4±2.5L，止血带放气组为 8.7±4.6L（P<.05）。止血带充气组术中及术后估计出血量分别为 95.3±25.1mL 和 240.3±44.5mL，止血带放气组分别为 230.2±22.3mL 和 75.6±15.3mL（P<.05）。两组患者术后疼痛、阿片类药物消耗、使用阿片类药物的患者比例、肿胀、平均血清 CPK 和 Hb 水平、主观和客观功能评分或移植物愈合情况无显著差异（P>.05）。
在前交叉韧带重建术中使用止血带可显著改善术中可视化效果，缩短手术时间，减少术中无菌生理盐水消耗和失血量，且不会增加严重不良事件或更高的并发症发生率，这基于早期术后结果。
I 级，随机对照试验。
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