Yang Yang, Zhang Meng-Qin, Zhang Jian-Min, Zhang Wei, Zhou Xiao-Bo, Wang Dan, Tung Tao-Hsin
Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Zhejiang, China; Department of Medical Education, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Zhejiang, China.
Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Zhejiang, China.
Arthroscopy. 2025 Jul;41(7):2568-2579. doi: 10.1016/j.arthro.2024.11.082. Epub 2024 Dec 2.
To assess the effects of tourniquet use on operative time, muscular injury, and postoperative pain in anterior cruciate ligament reconstruction.
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search was performed in EMBASE, PubMed, Web of Science, and the Cochrane Library for relevant randomized controlled trials (level of evidence: Level I), from inception to February 6, 2024. Data extraction included details such as first author, country, publication year, sample size, age, sex, tourniquet parameters (including inflation time and pressure), anesthesia, arthroscopic visualization, operative time, postoperative visual analog score, postoperative blood loss, postoperative morphine consumption within 24 hours, postoperative serum creatine phosphokinase levels, side-to-side thigh circumference difference after 3 weeks of surgery, and knee functional scores at the 6-month follow-up. Studies that met the inclusion criteria were assessed for risk of bias using the Cochrane Collaboration's tool.
Seven randomized controlled trials involving 471 participants were included in this study. Compared with the nontourniquet group, the tourniquet group had a significantly decreased operative time (mean difference [MD] -10.11, 95% confidence interval [CI] -15.74 to -4.49, P = .0004, I = 49%). In addition, the tourniquet group had significantly increased creatine phosphokinase levels compared with the nontourniquet group (MD 12.70, 95% CI 2.47-22.92, P = .01, I = 0%). Moreover, the tourniquet group had significantly greater visual analog scores 1 day postoperatively (MD 0.31, 95% CI 0.10-0.53, P = .005, I = 21%) and significantly greater postoperative blood loss (MD 156.33, 95% CI 134.05-178.60, P < .00001, I = 63%).
This meta-analysis found that the use of a tourniquet in anterior cruciate ligament reconstruction may decrease operative time but is associated with thigh muscle injury and increased postoperative pain.
Level I, meta-analysis of level I studies.
评估使用止血带对前交叉韧带重建手术时间、肌肉损伤及术后疼痛的影响。
本研究按照系统评价和Meta分析的首选报告项目指南进行。从数据库建库至2024年2月6日，在EMBASE、PubMed、科学网和Cochrane图书馆中全面检索相关随机对照试验（证据级别：I级）。数据提取内容包括第一作者、国家、发表年份、样本量、年龄、性别、止血带参数（包括充气时间和压力）、麻醉方式、关节镜视野、手术时间、术后视觉模拟评分、术后失血量、术后24小时内吗啡用量、术后血清肌酸磷酸激酶水平、术后3周大腿周径双侧差值以及术后随访6个月时的膝关节功能评分。使用Cochrane协作网工具对符合纳入标准的研究进行偏倚风险评估。
本研究纳入了7项涉及471名参与者的随机对照试验。与不使用止血带组相比，使用止血带组的手术时间显著缩短（平均差值[MD] -10.11，95%置信区间[CI] -15.74至-4.49，P = 0.0004，I² = 49%）。此外，与不使用止血带组相比，使用止血带组的肌酸磷酸激酶水平显著升高（MD 12.70，95% CI 2.47 - 22.92，P = 0.01，I² = 0%）。而且，使用止血带组术后1天的视觉模拟评分显著更高（MD 0.31，95% CI 0.10 - 0.53，P = 0.005，I² = 21%），术后失血量也显著更多（MD 156.33，95% CI 134.05 - 178.60，P < 0.00001，I² = 63%）。
本Meta分析发现，在前交叉韧带重建中使用止血带可能会缩短手术时间，但与大腿肌肉损伤及术后疼痛增加有关。
I级，I级研究的Meta分析。
