全膝关节置换术中止血带应用对假体骨水泥厚度影响的对照研究

发布时间：2018-09-05 07:12

【摘要】：目的探讨全膝关节置换术(TKA)中是否使用止血带对膝关节假体骨水泥厚度的影响。方法 2013年6月至2014年6月采用人工TKA治疗中重度骨性关节炎患者112例,其中94例为初次置换。按照选择标准共82例(82膝)患者纳入研究。所有患者随机分为非止血带组(41例膝)和止血带组(41例膝),止血带组术中全程使用止血带,非止血带组不使用止血带。所有患者术后行膝关节正侧位片检查,测量侧位片上股骨2个测量点,胫骨2个测量点和正位片上胫骨2个测量点假体下骨水泥厚度,同时记录分析两组的显性失血量、血红蛋白(Hb)降低值、输血率、平均输血量、视觉模拟评分法(VAS)疼痛评分、膝关节活动度、肢体肿胀、肌间静脉血栓、皮下淤斑等。结果两组均无术后感染、伤口坏死等并发症,非止血带组在围术期显性失血量、Hb降低值、输血率、平均输血量、膝关节活动度方面比较明显高于止血带组(P0.05),在VAS疼痛评分、肢体肿胀、肌间静脉血栓、皮下淤斑发生率方面明显低于止血带组(P0.05)。术后测量胫骨骨水泥厚度[非止血带组(3.57±0.62)mm,止血带组(3.74±0.71)mm)],股骨骨水泥厚度[非止血带组(2.00±0.43)mm,止血带组(2.19±0.48)mm],两组比较差异均无统计学意义(P0.05)。结论 TKA中使用止血带可以减少显性失血量、输血率及平均输血量,但不使用止血带有更好的临床效果。
[Abstract]:Objective To investigate the effect of tourniquet on bone cement thickness of knee prosthesis in total knee arthroplasty (TKA). Methods 112 patients with moderate to severe osteoarthritis were treated with artificial TKA from June 2013 to June 2014. 94 of them underwent primary replacement. Non-tourniquet group (41 knees) and tourniquet group (41 knees), tourniquet group used tourniquet throughout the operation, non-tourniquet group did not use tourniquet. Obvious blood loss, hemoglobin (Hb) reduction, blood transfusion rate, mean blood transfusion volume, visual analogue scale (VAS) pain score, knee joint activity, limb swelling, intramuscular venous thrombosis, subcutaneous ecchymosis, etc. were recorded and analyzed. Results There were no postoperative infection, wound necrosis and other complications in both groups. The VAS pain score, limb swelling, intramuscular venous thrombosis, and the incidence of subcutaneous ecchymosis in the tourniquet group were significantly lower than those in the tourniquet group (P 0.05). Bone cement thickness [non-tourniquet group (2.00.43) mm, tourniquet group (2.19.48) mm], there was no significant difference between the two groups (P 0.05). Conclusion The use of tourniquet in TKA can reduce the dominant blood loss, the blood transfusion rate and the average blood transfusion, but the use of tourniquet has better clinical effect.
【作者单位】：广东省佛山市第一人民医院骨科;
【分类号】：R687.4

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