Elbeshbeshy Mohamed, Azhar Muhammad Saad, Luqman Muhammad, Sabahuddin Ahmad, Bashir Oladimeji, Saber Ahmed Y, Parker James, Riaz Osman, McWilliams Timothy G, Aqil Adeel
Trauma and Orthopaedics, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, GBR.
Cureus. 2024 Nov 10;16(11):e73379. doi: 10.7759/cureus.73379. eCollection 2024 Nov.
Introduction Tourniquets are commonly used when performing total knee arthroplasty (TKA) to reduce intra-operative blood loss, improve surgical field visibility, and potentially improve cement penetration during prosthesis implantation. However, they may be associated with increased thigh pain, postoperative opiate use, and longer lengths of hospital stay. Methods Retrospectively collected data was obtained from our institution's electronic patient records and database. We compared data between those patients receiving a TKA with or without tourniquet use. Our primary outcome measure was cement penetration on immediate postoperative X-rays. Secondary outcome measures included the need for opiate analgesia, blood loss, need for transfusion, and length of hospital stay. Results There were 285 patients in this study, with 170 patients undergoing TKA with a tourniquet and 115 patients without a tourniquet. There was a significantly better median total cement penetration as measured on combined anteroposterior (AP) and lateral radiographs in the tourniquet group (39.14 vs 33.3mm, U=6991, z=-4.08, p<0.01). There was a statistically lower drop in hemoglobin levels when tourniquets were used (-13.4 (SD=8.6) vs -15.5 (SD=8.8), p=0.03). However, there were no cases in our series where patients required a transfusion. There was no significant difference in opiate analgesia requirements between tourniquet and non-tourniquet groups following surgery, 115 (68%) vs 69 (60%); X(1,285)=1.75, p=0.19. The median length of stay following surgery was slightly longer in the tourniquet group (2.5 vs 2.8 days); however, the Mann-Whitney U test indicated that this difference was not significant (U=9076, z=-0.70, p=0.31). Conclusion The use of a tourniquet was associated with significantly improved bone cement penetration as measured on postoperative AP and lateral radiographs. However, the clinical relevance of this in terms of implant survival remains controversial. Tourniquet use was also significantly associated with lower blood loss, but this did not translate into a lower need for transfusions. The use of a tourniquet was not associated with increased analgesia requirements following surgery or significantly longer lengths of stay.
在进行全膝关节置换术（TKA）时，通常会使用止血带以减少术中失血、提高手术视野清晰度，并可能在假体植入过程中改善骨水泥的渗透。然而，它们可能会导致大腿疼痛加剧、术后阿片类药物使用增加以及住院时间延长。
从我们机构的电子病历和数据库中回顾性收集数据。我们比较了接受TKA时使用或未使用止血带的患者的数据。我们的主要结局指标是术后即刻X线片上的骨水泥渗透情况。次要结局指标包括阿片类镇痛的需求、失血量、输血需求和住院时间。
本研究共有285例患者，其中170例患者在使用止血带的情况下接受了TKA，115例患者未使用止血带。在止血带组中，前后位（AP）和侧位X线片联合测量的骨水泥总渗透中位数明显更好（39.14 vs 33.3mm，U = 6991，z = -4.08，p <0.01）。使用止血带时血红蛋白水平的下降在统计学上更低（-13.4（标准差= 8.6）vs -15.5（标准差= 8.8），p = 0.03）。然而，我们的系列病例中没有患者需要输血。术后止血带组和非止血带组之间的阿片类镇痛需求没有显著差异，分别为115例（68%）和69例（60%）；X(1,285)=1.75，p = 0.19。止血带组术后的中位住院时间略长（2.5天 vs 2.8天）；然而，曼-惠特尼U检验表明这种差异不显著（U = 9076，z = -0.70，p = 0.31）。
根据术后AP和侧位X线片测量，使用止血带与骨水泥渗透显著改善相关。然而，这在植入物存活方面的临床相关性仍存在争议。使用止血带也与失血量显著减少相关，但这并未转化为更低的输血需求。使用止血带与术后镇痛需求增加或住院时间显著延长无关。
