Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan.
Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-Ku, Tokyo, 108-8329, Japan.
Sci Rep. 2023 Oct 18;13(1):17798. doi: 10.1038/s41598-023-45159-3.
Whether a tourniquet should be used for anterior cruciate ligament reconstruction (ACLR) when the operative field is secured remains controversial. Little is known about the influence of not using a tourniquet on total perioperative blood loss and soft tissue damage. The aim of this study was to compare total perioperative blood loss and soft tissue damage with and without tourniquet use during ACLR. Seventy-seven consecutive ACLRs in 76 patients were performed without tourniquet use at our hospital and enrolled in this study (T- group) between November 2018 and September 2021. The control group (T + group) comprised 55 historical ACLRs in 55 patients performed with tourniquet use at our hospital between April 2017 and September 2018. Total perioperative blood loss, calculated from the change in hemoglobin between that preoperatively and on postoperative day (POD) 1, and indicators of soft tissue damage including serum white blood cell (WBC) counts, creatine phosphokinase (CPK), and C-reactive protein (CRP) values measured on POD 1 and POD 7 were compared between groups. Total blood loss was significantly higher in the T- group (339 ± 216 mL) than in the T + group (258 ± 199 mL; P = 0.030). On POD 1, WBC counts were significantly higher in the T- group (9.7 ± 2.4 × 10 cells/µL) than in the T + group (9.1 ± 2.5 × 10 cells/µL; P = 0.043), CPK levels were significantly higher in the T- group (294 ± 417 U/L) than in the T + group (255 ± 88 U/L; P = 0.046), and CRP levels were also significantly higher in the T- group (1.40 ± 1.12 mg/dL) than in the T + group (0.91 ± 0.76 mg/dL; P = 0.016). No significant differences in WBC counts or CPK or CRP levels were seen between groups on POD 7. Total blood loss and soft tissue damage were significantly increased without tourniquet use during ACLR. No advantage was found for not using a tourniquet in terms of blood loss or soft tissue damage.
在进行前交叉韧带重建（ACLR）时，术野固定后是否应使用止血带仍然存在争议。关于不使用止血带对总围手术期失血和软组织损伤的影响知之甚少。本研究旨在比较 ACLR 时使用和不使用止血带对总围手术期失血和软组织损伤的影响。
2018 年 11 月至 2021 年 9 月，我院连续进行了 77 例无止血带使用的 ACLR，并将其纳入本研究（T 组）。对照组（T+组）为 2017 年 4 月至 2018 年 9 月我院使用止血带进行的 55 例 ACLR。通过术前和术后第 1 天（POD）1 之间的血红蛋白变化计算总围手术期失血，并比较两组之间软组织损伤的指标，包括术后第 1 天和第 7 天的血清白细胞（WBC）计数、肌酸磷酸激酶（CPK）和 C 反应蛋白（CRP）值。T 组的总失血量（339±216ml）明显高于 T+组（258±199ml；P=0.030）。术后第 1 天，T 组的 WBC 计数（9.7±2.4×10 细胞/µL）明显高于 T+组（9.1±2.5×10 细胞/µL；P=0.043），CPK 水平明显高于 T+组（294±417U/L）（255±88U/L；P=0.046），CRP 水平也明显高于 T+组（1.40±1.12mg/dL）（0.91±0.76mg/dL；P=0.016）。两组在 POD7 时的 WBC 计数或 CPK 或 CRP 水平均无显著差异。
在 ACLR 期间不使用止血带时，总失血量和软组织损伤明显增加。在失血或软组织损伤方面，不使用止血带没有优势。
