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在关节镜下前交叉韧带重建术中,止血带松开后控制术中出血是否有用?

Is Intraoperative Bleeding Control Useful After Tourniquet Release in Arthroscopic Anterior Cruciate Ligament Reconstruction?

作者信息

Çimen Oğuzhan, Azboy Ibrahim, Cengiz Bertan, Çavuş Mehmet, Karaoglu Sinan

机构信息

Orthopaedics and Traumatology, Medistanbul Hospital, Istanbul, TUR.

Orthopaedics, Medipol University, Istanbul, TUR.

出版信息

Cureus. 2023 Aug 28;15(8):e44253. doi: 10.7759/cureus.44253. eCollection 2023 Aug.

Abstract

Background Arthroscopic anterior cruciate ligament (ACL) reconstruction is a common orthopedic surgery, and rehabilitation is very important to achieve successful postoperative results. Postoperative hemarthrosis causes pain and limitation of movement, which prolongs the rehabilitation period. For these reasons, various strategies are used to reduce hemarthrosis in patients undergoing ACL reconstruction. This study aimed to evaluate the effect of bleeding control after releasing the tourniquet in ACL reconstruction surgery on the amount of hemarthrosis and pain in the postoperative period. Methodology A total of 60 patients who underwent arthroscopic single-bundle ACL reconstruction were enrolled in this prospective randomized control study. Bleeding control with the radiofrequency (RF) probe after releasing the tourniquet was done at the end of the arthroscopic ACL reconstruction in 30 patients (coagulation group) while bleeding control was not done for the other 30 patients (control group). Both groups were compared in terms of the degree of hemarthrosis using the Coupens and Yates classification in the early postoperative period and the degree of pain using the Visual Analog Scale (VAS) score and postoperative complications. Results In both groups, isolated ACL reconstruction was performed in 10 patients, additional partial meniscectomy in three patients, and additional arthroscopic meniscus repair in 17 patients. There was no statistically significant difference between the coagulation and control groups in terms of VAS (p > 0.05) and the degree of hemarthrosis (p > 0.05). Although the duration of tourniquet application was similar in both groups (p = 0.78), the duration of anesthesia was significantly longer in the coagulation group (p = 0.001). There was no significant difference between the groups in terms of postoperative complications. Conclusions Bleeding control with the RF probe after tourniquet release does not yield superior outcomes. More research with larger populations is needed to confirm these findings.

摘要

背景

关节镜下前交叉韧带(ACL)重建是一种常见的骨科手术,康复对于取得成功的术后效果非常重要。术后关节积血会导致疼痛和活动受限,从而延长康复期。由于这些原因,人们采用了各种策略来减少ACL重建患者的关节积血。本研究旨在评估ACL重建手术中松开止血带后进行出血控制对术后关节积血和疼痛程度的影响。

方法

本前瞻性随机对照研究共纳入60例行关节镜下单束ACL重建的患者。30例患者(凝血组)在关节镜下ACL重建结束时松开止血带后使用射频(RF)探头进行出血控制,而另外30例患者(对照组)未进行出血控制。在术后早期,使用库彭斯和耶茨分类法比较两组的关节积血程度,使用视觉模拟量表(VAS)评分比较两组的疼痛程度,并比较术后并发症。

结果

两组中,10例患者进行了单纯ACL重建,3例患者进行了额外的部分半月板切除术,17例患者进行了额外的关节镜下半月板修复。凝血组和对照组在VAS(p>0.05)和关节积血程度(p>0.05)方面无统计学显著差异。虽然两组的止血带应用时间相似(p = 0.78),但凝血组的麻醉时间明显更长(p = 0.001)。两组在术后并发症方面无显著差异。

结论

松开止血带后使用RF探头进行出血控制并未产生更好的效果。需要更多大规模人群的研究来证实这些发现。

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