止血带对初次全膝关节表面置换作用的Meta分析

目的：应用Meta分析系统总结评价止血带对初次全膝关表面节置换术（ TKA ）的作用。方法计算机检索Medline、Embase、Cochrane Library等数据库，纳入2000年1月至2013年4月间止血带与非止血带对TKA影响的临床随机对照研究。根据改良Jadad评分量表评价纳入研究质量，并采用RevMan 5.1软件进行Meta分析。结果共纳入13篇临床随机对照研究，共计662位患者。其中止血带组325例，非止血带组337例。结果显示使用止血带减少TKA术中失血量232.4ml （WMD＝-232.43，95％CI：-328.83，-156.03]），但增加了总体并发症发生率（RR＝2.11，95％CI：1.06，4.18]），两者差异均有显著性。两组间术后显性失血量（WMD ＝-5.80，95％CI：-176.25，164.64]）、总失血量（ WMD ＝67.36，95％CI：-58.74，193.46]）及血栓事件发生率（RR＝3.50，95％CI：0.75，16.44]）的差异无统计学意义。结论使用止血带可减少TKA术中失血量，但不能减少总失血量。止血带的使用增加了术后并发症的发生率。使用止血带与否不影响术后血栓事件发生率。

Meta-analysis of effects of tourniquet in primary total knee arthroplasty

Objective To evaluate the effects of tourniquet application in the primary total knee arthroplasty.Methods A literature search was done from January 2000 to April 2013 in Medline, Embase, Cochrane Library and other databases .The reference lists of the relevant articles were also looked＆amp;nbsp;through for any further relevant studies .The methodological quality of the included studies was assessed by the advanced Jadad scale .The analyses were performed with Cochrane RevMan software version 5.1. Results 13 randomized controlled trials were obtained eventually .These studies involved a total of 662 patients who underwent TKA with or without the tourniquet , 325 cases in the tourniquet group and 337 cases in the non-tourniquet group .The meta-analysis showed that using a tourniquet in TKA significantly decreased the intraoperative blood loss by 232.4 ml （ WMD =-232.43, 95%CI： -328.83,-156.03]）.The tourniquet group had a higher incidence of complications than the non -tourniquet group （RR=2.11,95%CI：1.06,4.18]）.No significant difference was observed in the postoperative dominant blood loss, total blood loss and the incidence of thromboembolic events （ WMD =67.36, 95%CI：-58.74,193.46];WMD =-5.80, 95%CI： -176.25,164.64]; RR =3.50,95%CI： 0.75, 16.44];respectively）.Conclusion The total blood loss in TKA with a tourniquet may not be reduced , although intraoperative blood might be significantly less .Using a tourniquet in TKA may have higher risk of complications ., and does not affect the incidence of thromboembolism .