ACRS  >> Vol. 5 No. 2 (June 2016)

    The First Half and Full Use of a Tourniquet Comparison of Early Rehabilitation and Blood Loss after Knee Replacement

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周 峰,夏长所,李娅娟,韩建玲,张才龙:青岛大学附属医院东区关节外科,山东 青岛

全膝关节置换术气压止血带失血量早期功能恢复Total Knee Replacement Pneumatic Tourniquet Blood Loss Volume Early Functional Recovery


研究目的:研究完成假体安放后释放止血带与全程使用止血带在全膝关节置换术后失血与早期康复的对比。方法:本研究采用前瞻随机对照研究,选择2015年3月1日至2016年7月1日于青岛大学附属医院关节外科收入院,诊断均为左(或右)膝骨关节炎,并且初次行全膝关节置换术(TKA)者,术中分别将各50名符合纳入条件的患者随机分为2组:前半程使用止血带50例(前半程组),全程使用止血带50例(全程组)。记录手术时间、术中出血量、围手术期的输血量、下肢深静脉血栓形成、肺栓塞人数,术后3天患肢膝上10 cm周径、术后7天VAS评分、HSS评分、产生张力性水泡例数、术后3天CPM功能锻炼度数、入院HCT、术后第一天引流量、HCT,术后第二天引流量、术后第三天HCT,并进行组间比较。结果:前半程组与全程组相比较,手术时间较长,术后第一、三天HCT值较高,术中失血量较多,术中红细胞丢失较多,总红细胞丢失量较少,隐性红细胞丢失量较少,术后第一、二天引流量少,患者术后1周HSS评分较高,术后3天患肢膝上10 cm周径较小,术后7天VAS评分较低,术后3天CPM达到的度数较大,产生张力性水泡的人数较少,差异均有统计学意义。而术后红细胞丢失量、显性红细胞丢失量差异无统计学意义。两组均无下肢静脉血栓、肺栓塞等并发症发生。结论:前半程应用止血带组相比较全程应用止血带组,不仅减少术后隐性红细胞丢失量及总红细胞丢失量,还利于患者早期恢复,且不增加发生下肢静脉血栓、肺栓塞等并发症的发生率,值得大家采纳。

Research Purpose: To compare the releasing tourniquet after prothesis placement using tourniquet during the whole-course in the case of hemorrhage resulting from total knee joint replacement and early rehabilitation. Method: Adopting prospective randomized controlled method, the research has taken the cases in the Surgical Department of Affiliated Hospital of Qingdao University from March 1, 2015 to July 1, 2016 as examples. Patients were diagnosed with left (right) knee osteoarthritis and the first time to receive total knee replacement (TKA). During operation 50 pa-tients were divided into two groups at random: the first half cases used 50 tourniquets (first half group), and patients using tourniquets during the whole course were 50 cases (whole course group). Duration of operation, bleeding volume in surgery, perioperative transfusion volume, deep vein thrombosis of the lower extremity, pulmonary embolism number, perimeter of 10 cm above knee 3 days after operation, VAS score of 7 days after operation, HSS score, number of tension vesicle cases, CPM functional exercise degree 3 days after operation, admission HCT, drainage volume on the 1st day after operation, and HCT 3 days after operation were recorded and compared between groups. Outcome: Compared with the whole course group, the first half group had longer duration of operation; HCT value was higher on the 1st and 3rd day of the operation; bleeding volume and amount of erythrocyte loss were larger during operation; total erythrocyte and hidden erythrocyte loss were less; drainage volume was less after the 1st and 2nd days of operation; patient’s HSS score was higher after a week of operation; perimeter of 10 cm above knee was smaller 3 days after operation; VAS score was lower 7 days after operation; CPM functional exercise degree reached higher 3 days after operation; number of tension vesicle cases was smaller; the differences were of statistical significance. Conclusion: Compared with the whole course group, using tourniquets in the first half group not only has reduced hidden erythrocyte loss and total erythrocyte loss, but also was beneficial to patients’ early recovery, dropping incidence rate of phlebothrombosis, pulmonary embolism and other complications. Therefore it is worth adopting.

周峰, 夏长所, 李娅娟, 韩建玲, 张才龙. 前半程与全程使用止血带在膝关节置换术后失血与早期康复的对比[J]. 亚洲外科手术病例研究, 2016, 5(2): 10-16.


[1] Tahmasebi, M.N., et al. (2014) Intraarticular Administration of Tranexamic Acid Following Total Knee Arthroplasty: A Case-Control Study. Archives of Bone and Joint Surgery, 2, 141-145.
[2] Feng, B., et al. (2014) Long Term Follow-Up of Clinical Outcome between Patellar Resurfacing and Nonresurfacing in Total Knee Arthroplasty: Chinese Experience. Chinese Medical Journal (English Edition), 127, 3845-3851.
[3] Liu, J.T., et al. (2014) Bilateral Total Knee Arthroplasty for Charcot Knees Associated with Tabes Dorsalis. Pain Physician, 17, E796-E799.
[4] Marya, S.K. and Thukral, R. (2013) Outcome of Unicompartmental Knee Arthroplasty in Octogenarians with Tricompartmental Osteoarthritis: A Longer Follow-Up of Previously Published Report. Indian Journal of Orthopaedics, 47, 459-468.
[5] Abdel-Salam, A. and Eyres, K.S. (1995) Effects of Tourniquet during Total Knee Arthroplasty. A Prospective Randomised Study. Journal of Bone and Joint Surgery, British Volume, 77, 250-253.
[6] Holmberg, A., Milbrink, J. and Bergqvist, D. (1996) Arterial Complications after Knee Arthroplasty: 4 Cases and a Review of the Literature. Acta Orthopaedica Scandinavica, 67, 75-78.
[7] Norton, M.R. and Eyres, K.S. (2000) Irrigation and Suction Technique to Ensure Reliable Cement Penetration for Total Knee Arthroplasty. Journal of Arthroplasty, 15, 468-474.
[8] Huang, Z., et al. (2012) Mini-Midvastus versus Medial Parapatellar Approach in TKA: Muscle Damage and Inflammation Markers. Orthopedics, 35, e1038-E1045.
[9] Tai, T.W., et al. (2011) Tourniquet Use in Total Knee Arthroplasty: A Meta-Analysis. Knee Surgery Sports Traumatology Arthroscopy, 19, 1121-1130.
[10] Alcelik, I., et al. (2012) A Comparison of Outcomes with and without a Tourniquet in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Ar-throplasty, 27, 331-340.
[11] Pulido, L., et al. (2008) In Hospital Complications after Total Joint Arthroplasty. Journal of Arthroplasty, 23, 139-145.
[12] Huang, Z., et al. (2013) Meta-Analysis of Temporary versus No Clamping in TKA. Orthopedics, 36, 543-550.
[13] 李军, 荆珏华. 止血带对全膝关节置换术失血量和软组织损伤的影响: 一项随机对照研究[J]. 临床骨科杂志, 2013(1): 78.
[14] Yavarikia, A., Amjad, G.G. and Davoudpour, K. (2010) The Influence of Tourniquet Use and Timing of Its Release on Blood Loss in Total Knee Arthroplasty. Pakistan Journal of Biological Sciences, 13, 249-252.
[15] Matziolis, D., et al. (2011) Influence of Tourniquet Ischemia on Perioperative Blood Loss after Total Knee Arthroplasty. Orthopädie, 40, 178-182.
[16] Clarke, M.T., et al. (2001) Tourniquet-Induced Wound Hypoxia after Total Knee Replacement. The Journal of Bone and Joint Surgery, 83, 40-44.
[17] Mittal, R., et al. (2012) Tourniquet Application Only during Cement Fixation in Total Knee Arthroplasty: A Double- Blind, Randomized Controlled Trial. ANZ Journal of Surgery, 82, 428-433.
[18] Lotke, P.A., et al. (1991) Blood Loss after Total Knee Replacement. Effects of Tourniquet Release and Continuous Passive Motion. The Journal of Bone and Joint Surgery, 73, 1037-1040.
[19] Jefferiss, C.D., Lee, A.J. and Ling, R.S. (1975) Thermal Aspects of Self-Curing Polymethylmethacrylate. The Journal of Bone and Joint Surgery, 57, 511-518.
[20] 杜哲, 等. 人工全膝关节置换术中止血带应用对围手术期失血量及近期疗效的影响研究[J]. 中国修复重建外科杂志, 2013(11): 1318-1323.
[21] Ledin, H., Aspenberg, P. and Good, L. (2012) Tourniquet Use in Total Knee Replacement Does Not Improve Fixation, but Appears to Reduce Final Range of Motion. Acta Orthopaedica, 83, 499-503.
[22] Vandenbussche, E., Duranthon, L.-D., Couturier, M., Pidhorz, L. and Augereau, B. (2002) The Effect of Tourniquet Use in Total Knee Arthroplasty. International Orthopaedics, 26, 306-309.
[23] Zhang, W., et al. (2014) The Effects of a Tourniquet Used in Total Knee Arthroplasty: A Meta-Analysis. Journal of Orthopaedic Surgery and Research, 9, 13.
[24] Fan, Y., et al. (2014) The Limited Use of a Tourniquet during Total Knee Ar-throplasty: A Randomized Controlled Trial. Knee, 21, 1263-1268.
[25] 邱贵兴. 中国骨科大手术静脉血栓栓塞症预防指南[J]. 中华关节外科杂志(电子版), 2009(3): 380-383.
[26] Watanabe, H., et al. (2014) Changes in Blood Coagulation-Fibrinolysis Markers by Pneumatic Tourniquet during Total Knee Joint Arthroplasty with venous Thromboembolism. Journal of Arthroplasty, 29, 569-573.
[27] Hirota, K., et al. (2001) The Relationship between Pneumatic Tourniquet Time and the Amount of Pulmonary Emboli in Patients Undergoing Knee Arthroscopic Surgeries. Anesthesia and Analgesia, 93, 776-780.