全膝关节置换术后止血带性缺血再灌注损伤的临床研究

目的 探讨全膝关节置换术(TKA)中使用止血带是否会导致缺血再灌注损伤，进而加重各项不良并发症。方法 2009年1月至2010年10月共收治52例拟行初次TKA的患者，采用随机数学表法分为2组：使用止血带组（A组）和未使用止血带组（B组），每组26例。A组：男11例，女15例；年龄69 ～ 76岁，平均72.5岁。B组：男12例，女14例；年龄67 ～ 77岁，平均72.9岁。两组患者术前一般资料比较差异均无统计学意义(P＞0.05)，具有可比性。术后股四头肌活检观测股四头肌肌肉的病理改变，记录并比较两组患者的术后肿胀程度、疼痛视觉模拟评分(VAS)、关节活动度及肌力。结果 A组病理切片示股四头肌溶解，大量中性粒细胞浸润；B组为正常肌肉组织。A组术后1、3、7及14d小腿肿胀程度、膝关节周径及股四头肌肿胀程度的增加率均显著大于B组，差异有统计学意义(P＜0.05)。A组术后6h、1d、3d、5d、7 dVAS疼痛评分明显高于B组，差异均有统计学意义(P＜0.05)；而术后14d两组VAS疼痛评分差异无统计学意义(P＞0.05)。B组患者术后3d、7d、14d及1个月膝关节自主活动度均高于A组，术后1、3、7、14d直腿抬高度数也明显优于A组，差异均有统计学意义(P＜0.05)。结论 TKA中使用止血带可引起缺血再灌注损伤，进而加重各项不良并发症的发生。

Tourniquet ischemia reperfusion injury after total knee arthroplasty in clinical research

Objective To explore whether use of tourniquet in total knee arthroplasty (TKA) will lead to increased risks of ischemia-reperfusion injury and adverse complications. MethodsFifty-two patients who were to undergo primary TKA between January, 2009 and October, 2010 were randomly divided into 2 equal groups. A tourniquet was used in group A but not in group B. In group A, there were 11 males and 15 females; aged from 69 to 76 years (mean, 72. 5 years); in group B, there were 12 males and 14 females, aged 67 to 77 years (mean, 72.9 years). There were no statistically significant differences between the 2 groups in demographic characteristics before surgery. Pathological changes in the quadriceps muscle were compared between the 2 groups through biopsy. Severity of postoperative swelling, pain scores by visual analogue scale (VAS), range of motion and muscle strength were recorded and compared between the 2 groups.ResultsThe biopsy showed dissolved quadriceps and massive neutrophil infiltration in group A but normal muscle tissue in group B. Swellings of the calf, the knee and the quadriceps at 1, 3, 7 and 14 days after surgery were all significantly more severe in group A than in group B ( P ＜ 0. 05 ). The VAS pain scores at 6 hours, 1, 3, 5, 7 days were significantly higher in group A than in group B ( P ＜ 0. 05 ), but there was no significant difference in the VAS pain score at 14 days between the 2 groups ( P ＞ 0. 05). Group B had a significantly greater range of spontaneous activity of the knee at 3, 7, 14 days and 1 month after surgery than group A( P ＜0. 05); group B also showed significantly better straight leg raising at 1, 3, 7, 14 days than group A ( P ＜ 0. 05) .Conclusion TKA using tourniquet may increase risks of ischemia-reperfusion injury and adverse complications.