摘要
背景:关于全膝关节置换中止血带使用与否的术后效果对比已有报道,但鲜有文献明确提出限制性使用止血带和不使用止血带术后效果的差异。目的:观察全膝关节置换中限制性使用和不使用止血带对患者术后加速康复的影响。方法:随机选取2017年7月至2018年12月在成都中医药大学附属医院接受全膝关节置换治疗的患者90例,将患者随机分为3组:(1)限制使用止血带组:截骨完成后,仅于假体安装时应用止血带治疗,于膝关节假体成功放置且骨水泥硬化时结束;(2)后半程使用止血带组:截骨完成后,安装假体时开始使用止血带,直到切口缝合加压包扎;(3)不使用止血带组:全程不使用止血带,每组各30例。各组患者皆采用同样的围术期处理及加速康复训练,比较3组患者术后静脉血血红蛋白水平、C-反应蛋白水平、目测类比及HSS评分变化。结果与结论:(1)与限制性使用组和不使用止血带组比较,后半程使用止血带组术后1,3 d的膝关节疼痛目测类比评分和静脉血C-反应蛋白水平及术后1d血红蛋白水平升高(P<0.05),术后3,7d膝关节HSS评分降低(P<0.05);(2)术后限制使用止血带组和不使用止血带组的目测类比评分、HSS评分、C-反应蛋白及血红蛋白水平无显著差异;(3)结果证实,限制性使用止血带与不使用止血带对全膝关节置换后早期康复效果无明显差异,全膝关节置换后半程使用止血带会加重术后早期疼痛。
BACKGROUND: A comparison of the postoperative effects of the use of tourniquet has been reported, but few literatures have clearly indicated differences in the effects of restrictive use of tourniquets and no use of tourniquets.OBJECTIVE: To investigate the effects of restrictive use and non-use of tourniquet in patients undergoing preliminary total knee arthroplasty within enhanced recovery after surgery mode.METHODS: Totally 90 patients who underwent total knee arthroplasty in Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from July 2017 to December 2018 were enrolled. The patients were randomly divided into three groups(n=30 per group) according to the method of the tourniquet during the operation. In the restrictive use group, after the osteotomy was completed, only the tourniquet treatment was applied when th e prosthesis was installed, and the knee joint prosthesis was successfully placed and the cement was hardened. In the second half use group, after the osteotomy was completed, the tourniquet was used when the prosthesis was installed until the incision was sutured and pressur e-wrapped. In the non-use group, no inflated tourniquet was used during operation. The same perioperative management and rehabilitation training were used in all patients of each group. Hemoglobin, C-reactive protein, visual analogue scale scores and HSS score were observed and compared between groups.RESULTS AND CONCLUSION:(1) Compared with the restrictive use group and the non-use group, the knee visual analogue scale scores and C-reactive protein level at 1 and 3 days after operation and the hemoglobin level at 1 day after operation both increased in th e second half use group(P < 0.05); however, the knee HSS scores at 3 and 7 days decreased(P < 0.05).(2) There were no significant differences in visual analogue scale score, HSS score, C-reactive protein, and hemoglobin levels between the restrictive use group and the non-use group after surgery.(3) There was no significant difference in the early postoperative rehabilitation between the restrictive use and non-use tourniquet,but the use of tourniquets in the second half would aggravate early postoperative pain.
引文
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