止血带的不同使用方法在膝关节置换术中的研究

目的探讨全膝关节置换术中止血带不同的使用方法的作用。方法2009年9月至2011年6月，对45例骨关节炎患者行单侧膝关节置换手术，根据止血带不同的使用方法分为两组，A组24例，在安装假体前至安装假体后骨水泥硬松开止血带；B组21例，在手术开始至安装假体完毕，骨水泥硬化后松开止血带，术野止血后关闭伤口。观察两组病例的手术时间、术中和术后出血量、术后患肢肿胀情况和术后HSS评分。结果手术时间（t=3．0，P〈0．05）、术中（t=9．2，P〈0．05）和术后（t=13．5，P〈0．05）出血量均有统计学差异，但是总出血量（t=0．6，P〉0．05）间的差异无统计学意义，术后患肢肿胀情况（t=2．3，P〈0．05）两组间差异具有统计学意义。结论减少使用止血带时间可能利于患者早期恢复。

Two different methods of tourniquet application in total knee arthroplasty

Objective To analysis the effects of two different ways using tourniquet on blood loss and soft-tissue damage in total knee arthroplasty （TKA）. Methods Between September 2009 and June 2011,45 patients （45 knees ） who had consecutively undergone unilateral total knee arthroplasty were divided into two groups according to the different methods of tourniquet use. In group A （24 patients） , the tourniquet was not used until installation prosthesis and was released after bone cement hardening. In Group B： （21 patients）, tourniquet was applied from the beginning of the operation to the bone cement hardening. Surgical time, blood loss, swelling and postoperative HSS score were recorded for comparison. Results There were significant differences between the groups in terms of the surgery time （ t = 3.0, P 〈 0. 05 ） , blood loss during operation （ t = 9.2, P 〈 0. 05） and after operation （ t = 13.5, P 〈 0. 05 ）, as well as in limb swelling （ t = 2. 3, P 〈 0. 05 ）. But there was no significant difference in total blood loss between the two groups （ t = 0. 6, P 〉 0. 05 ）. Conclusions Decreasing the duration of tourniquet use in total knee arthroplasty may lead to less limb swelling and probably has benefit for early postoperative recovery.