Lin Zhengwu, Chen Te, Chen Guofu, Pan Wenjun, Xu Wei
Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China.
Department of Special Requirements Ward, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China.
Int Wound J. 2023 Oct 1;21(2). doi: 10.1111/iwj.14414.
The application of a tourniquet (TNQ) for haemostasis in total knee arthroplasty (TKA) is controversial and lacking systematic evaluation. This meta-analysis assessed relevant international data to quantitatively evaluate the implications of using TNQ in TKA, further guide clinical diagnosis and treatment, and improve postoperative outcomes. A comprehensive computerised search of PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP, and Wanfang databases was conducted to retrieve randomised controlled trials on the application of TNQ in TKA published from database inception to August 2023. The included data, ultimately comprising 1482 patients in 16 studies, were collated and subjected to meta-analysis using Stata 17.0 software. The results showed that the use of TNQ during TKA led to significantly higher rates of postoperative surgical site wound infection (3.96% vs. 1.79%, odds ratio: 2.15, 95% confidence intervals [CIs]: 1.11-4.16, p = 0.023) and wound pain scores on the first (standardised mean difference [SMD]: 0.65, 95% CI: 0.35-0.94, p < 0.001), second (SMD: 0.66, 95% CI: 0.01-1.31, p = 0.045), and third (SMD: 0.68, 95% CI: 0.31-1.05, pP < 0.001) day after the procedure. In conclusion, the application of TNQ in TKA increases the risk of postoperative surgical site wound infection and worsens short-term postoperative wound pain; therefore, TNQ should be used sparingly during TKA, or its use should be decided in conjunction with the relevant clinical indications and the surgeon's experience.
在全膝关节置换术（TKA）中使用止血带（TNQ）进行止血存在争议且缺乏系统评价。本荟萃分析评估了相关国际数据，以定量评估在TKA中使用TNQ的影响，进一步指导临床诊断和治疗，并改善术后结果。通过对PubMed、Embase、Cochrane图书馆、中国知网、维普和万方数据库进行全面的计算机检索，以检索从数据库建立至2023年8月发表的关于TNQ在TKA中应用的随机对照试验。最终纳入的16项研究中的1482例患者的数据进行整理，并使用Stata 17.0软件进行荟萃分析。结果显示，TKA期间使用TNQ导致术后手术部位伤口感染率显著更高（3.96%对1.79%，比值比：2.15，95%置信区间[CI]：1.11 - 4.16，p = 0.023），以及术后第一天（标准化平均差[SMD]：0.65，95% CI：0.35 - 0.94，p < 0.001）、第二天（SMD：0.66，95% CI：0.01 - 1.31，p = 0.045）和第三天（SMD：0.68，95% CI：0.31 - 1.05，p < 0.001）的伤口疼痛评分更高。总之，在TKA中应用TNQ会增加术后手术部位伤口感染的风险，并使术后短期伤口疼痛加剧；因此，在TKA期间应谨慎使用TNQ，或应结合相关临床指征和外科医生的经验来决定是否使用。
