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带或不带止血带?无合并症患者全膝关节置换术的比较研究。

With or without a Tourniquet? A Comparative Study on Total Knee Replacement Surgery in Patients without Comorbidities.

机构信息

Department of Orthopaedics and Traumatology, Ozel Tekirdag Yasam Hospital, 59030 Tekirdag, Turkey.

Department of Physiotherapy, Vocational School of Health Services, Istanbul Rumeli University, 34750 Istanbul, Turkey.

出版信息

Medicina (Kaunas). 2023 Jun 25;59(7):1196. doi: 10.3390/medicina59071196.

Abstract

This study aimed to determine the effects of tourniquet use and the complications of total knee arthroplasty (TKA) in patients without comorbidities to investigate whether tourniquet application can be employed without adverse effects and to assess its impact on the occurrence of any complications. A total of 106 patients who underwent unilateral TKA were divided randomly into two groups according to whether a tourniquet was used during the surgery or not. Patients with comorbidities (except arterial hypertension) were excluded from the study. Knee Injury and Osteoarthritis Outcome Score, joint range of motion, visual analog scale (VAS) score, total blood loss during and after surgery, postoperative analgesic consumption, and side effects were the main factors evaluated in the study. In the tourniquet group, where the VAS scores were higher, the use of analgesics was also significantly higher. While there was no statistically significant difference in total blood loss between the tourniquet and non-tourniquet groups, the postoperative and occult blood losses were higher in the tourniquet group. The differences between the two groups in all other parameters were very small and not statistically significant. The findings of the current study suggest that when the comorbidities of patients are thoroughly documented and clarified prior to surgery, tourniquets should be applied selectively to individuals without any pre-existing health conditions.

摘要

本研究旨在确定无合并症患者使用止血带和全膝关节置换术(TKA)的并发症的影响,以探讨是否可以在没有不良影响的情况下使用止血带,并评估其对任何并发症发生的影响。 共有 106 名接受单侧 TKA 的患者根据手术过程中是否使用止血带随机分为两组。 排除有合并症(除动脉高血压外)的患者。 膝关节损伤和骨关节炎结果评分、关节活动范围、视觉模拟量表(VAS)评分、手术期间和手术后总失血量、术后止痛药物消耗以及副作用是本研究的主要评估因素。 在止血带组中,VAS 评分较高,止痛药的使用也明显更高。 虽然止血带组和非止血带组之间总失血量没有统计学上的显著差异,但止血带组的术后和隐性失血量更高。 两组在所有其他参数上的差异非常小,且无统计学意义。 本研究结果表明,当患者的合并症在手术前得到彻底记录和明确时,应选择性地向没有任何既往健康状况的个体使用止血带。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5404/10386593/ac5619e3c7bf/medicina-59-01196-g001.jpg

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