不使用止血带在全膝关节置换术中的临床效果评价

发布时间：2018-06-14 16:54

本文选题：止血带 + 全膝关节置换术　；参考：《中国矫形外科杂志》2017年23期

【摘要】：[目的]研究全膝关节置换(TKA)术中不使用止血带的综合效果及其对早期功能恢复的作用。[方法]本院2016年10月~2017年3月住院并初次接受单侧TKA术的60例西藏藏族患者。依照随机数字表法分为不使用止血带组和使用止血带组,每组30例。研究组全程不使用止血带,对照组全程使用止血带,均不放置引流。对比两组手术时间、术中出血量、术后隐性失血量、围手术期总失血量、疼痛评分(VAS)、肿胀、膝关节功能恢复及深静脉血栓(DVT)的发生情况。[结果]不使用止血带组手术时间与使用止血带组差异无统计学意义(P0.05),术中失血量显著高于使用止血带组(P0.05),术后隐性失血量明显少于使用止血带组(P0.05),围手术期总失血量两组差异无统计学意义(P0.05)。不使用止血带组术后第1、3、7 d大腿疼痛及膝关节疼痛VAS评分均低于使用止血带组(P0.05)。术后第3、7 d不使用止血带组患肢肿胀度均小于使用止血带组(P0.05)。不使用止血带组屈膝100°时间快于使用止血带组(P0.05)。两组均无症状性DVT发生,不使用止血带组发生肌间静脉血栓6例(20.00%),使用止血带组发生肌间静脉血栓7例(23.33%),组间比较差异无统计学意义(P0.05)。[结论]TKA术中全程不使用止血带可以减轻术后大腿肌肉、膝关节疼痛及肿胀,加快膝关节功能康复,且不会增加围术期总失血量和DVT。
[Abstract]:[objective] to study the comprehensive effect of using tourniquet without tourniquet during total knee arthroplasty (TKA) and its effect on early functional recovery. [methods] from October 2016 to March 2017, 60 Tibetan patients with unilateral TKA were admitted to our hospital for the first time. According to the random number table method, the patients were divided into two groups: the non-tourniquet group and the tourniquet group with 30 cases in each group. No tourniquet was used in the study group and no drainage was placed in the control group. The time of operation, the amount of intraoperative bleeding, the amount of recessive blood loss after operation, the total amount of blood loss in perioperative period, the pain score of VASA, the swelling, the recovery of knee joint function and the occurrence of DVT were compared between the two groups. [results] there was no significant difference in the operative time between the non-use tourniquet group and the tourniquet group. The amount of intraoperative bleeding was significantly higher than that in the tourniquet group (P0.05), and the amount of recessive bleeding after operation was significantly less than that in the tourniquet group, and the total perioperative period was significantly lower than that in the tourniquet group. There was no significant difference in blood loss between the two groups (P 0.05). The VAS scores of thigh pain and knee joint pain in the non-tourniquet group were lower than those in the tourniquet group on the 1st and 7th day after operation (P 0.05). The swelling degree of the affected limbs in the non-tourniquet group was lower than that in the tourniquet group on the 3rd day after operation (P 0.05). The time of 100 掳flexion in the non-tourniquet group was faster than that in the tourniquet group (P 0.05). There were no symptomatic DVT in the two groups, 6 cases of intramuscular venous thrombosis occurred in the non-tourniquet group and 7 cases in the tourniquet group. There was no significant difference between the two groups (P 0.05). [conclusion] TKA without tourniquet during the whole operation can relieve the pain and swelling of thigh muscle and knee joint, accelerate the rehabilitation of knee joint function, and do not increase the total blood loss and DVT during perioperative period.
【作者单位】：西藏自治区人民政府驻成都办事处医院骨科;
【分类号】：R687.4

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