Tan Yong Yao, Ang Ke Xin Magneline, Tun Mon Hnin, Loh Sir Young James
Changi General Hospital, Singapore.
J Orthop. 2024 Mar 11;54:46-50. doi: 10.1016/j.jor.2024.03.007. eCollection 2024 Aug.
Tourniquet use during total knee arthroplasty (TKA) reduces bleeding which optimises bone-cement interface for prosthesis stability and improves surgical field visualisation. However, prolonged usage can lead to complications and poorer outcomes. Some surgeons advocate for intermittent tourniquet application. Limited literature exists for patients with high body mass index (BMI). This study aims to compare the outcomes of intermittent tourniquet (IT) to throughout tourniquet (TT) use among obese patients undergoing primary TKA for knee osteoarthritis.
This was a retrospective cohort study. In the TT group, tourniquet was inflated from the beginning and released once the bone cement has hardened. In the IT group, tourniquet was inflated at the beginning, released after initial incision and haemostasis, then inflated again during cementation. Tourniquet was released once the bone cement had set. Categorical outcome measures were analysed using Chi-squared or Fisher's exact test. T-test or Kruskal-Wallis test were used for continuous data.
When comparing IT to TT among patients with BMI≥30 (IT n = 48, TT n = 47), the mean duration of surgery was shorter in the TT group (p < 0.05). The difference in haemoglobin drop between the two groups was not statistically significant from post-operative day three onwards. There was no difference in transfusion rate (p > 0.05). ROM was greater in the IT group up to three weeks post-operatively (p < 0.05). When comparing patients with BMI <30 (n = 71) and BMI≥30 (n = 48) with IT use, there was no statistically significant difference in ROM and LOS.
Patients with BMI≥30 in the IT group had greater ROM in the initial post-operative period. Although operative time and blood loss were greater among the IT group, there was no difference in transfusion rate. Outcomes of TKA performed with IT were similar for patients with BMI≥30 and BMI <30. The authors recommend intermittent tourniquet use during TKA for patients with BMI≥30.
全膝关节置换术（TKA）中使用止血带可减少出血，从而优化骨水泥界面以确保假体稳定性，并改善手术视野的清晰度。然而，长时间使用可能会导致并发症并降低手术效果。一些外科医生主张间歇性使用止血带。针对体重指数（BMI）较高的患者，相关文献有限。本研究旨在比较间歇性止血带（IT）与全程止血带（TT）在因膝关节骨关节炎接受初次TKA的肥胖患者中的使用效果。
这是一项回顾性队列研究。在TT组中，止血带从手术开始时充气，骨水泥硬化后松开。在IT组中，止血带在手术开始时充气，初始切口和止血后松开，然后在骨水泥固定期间再次充气。骨水泥凝固后松开止血带。分类结局指标采用卡方检验或Fisher精确检验进行分析。连续数据采用t检验或Kruskal-Wallis检验。
在BMI≥30的患者中比较IT组（n = 48）和TT组（n = 47）时，TT组的平均手术时间较短（p < 0.05）。从术后第3天起，两组之间血红蛋白下降的差异无统计学意义。输血率无差异（p > 0.05）。术后三周内，IT组的关节活动度（ROM）更大（p < 0.05）。在比较BMI < 30（n = 71）和BMI≥30（n = 48）且使用IT的患者时，ROM和住院时间（LOS）无统计学显著差异。
IT组中BMI≥30的患者在术后初期的ROM更大。尽管IT组的手术时间和失血量更多，但输血率无差异。BMI≥30和BMI < 30的患者使用IT进行TKA的效果相似。作者建议BMI≥30的患者在TKA期间间歇性使用止血带。
3级。
