阶段性使用止血带对全膝关节置换术后关节功能康复的影响

目的：探讨止血带不同使用方式对全膝关节置换（total knee arthroplasty，TKA）术后关节功能康复的影响。方法：选取2019年2—12月南京医科大学附属南京医院关节外科同一手术团队完成的单侧、初次TKA患者120 例，随机分为3组：无止血带组（A组），全程不使用止血带；全程止血带组（B组），手术全程使用止血带；阶段性使用止血带组（C组），仅在截骨后假体安放阶段使用止血带。比较3组间手术时间，术中出血量，手术前后血红蛋白、红细胞压积及磷酸肌酸激酶，术后第1、7天疼痛视觉模拟评分（visual analogue scale，VAS评分）、膝关节协会功能评分（knee society score，KSS评分），患肢周径手术前后变化及并发症发生情况。结果：3组患者均得到有效随访观察。在手术时间、术中出血量方面，B组优于C组，C组优于A组，差异有统计学意义（P＜0.05）。在患肢周径（髌骨上极20 cm）手术前后差值方面，A组优于C组，C组优于B组，差异有统计学意义（P＜0.05）。在术后第1天及第7天VAS评分、术后第1天及第7天KSS评分方面，A组和C组优于B组，差异有统计学意义（P＜0.05），A组和C组之间差异无统计学意义（P＞0.05）。3组患者手术前后血红蛋白差值、红细胞压积差值、磷酸肌酸激酶差值、患肢周径（髌骨上极以及下极10 cm）手术前后差值以及术后并发症差异无统计学意义（P＞0.05）。结论：TKA术中阶段性使用止血带可有效减少手术时间及术中出血，减轻患者术后肢体疼痛及肿胀程度，促进TKA术后关节功能康复，早期临床效果满意。

The effect of using tourniquet in stages on the rehabilitation of joint function after total knee arthroplasty

ObjectiveTo explore the effect of different tourniquet use methods on the rehabilitation of joint function after total knee arthroplasty (TKA).MethodsA total of 120 unilateral and primary TKA patients completed by the same surgical team in the joint surgery department of our hospital from February to December 2019 were randomly divided into 3 groups: group A (no tourniquet group) did not use tourniquets during the whole process; group B (all courses Tourniquet group) tourniquet was used throughout the operation; group C (stage tourniquet group) was used only during the post-osteotomy prosthesis placement stage.The operation time, intraoperative bleeding volume, hemoglobin, hematocrit and creatine phosphokinase, visual analogue scale (VAS), Knee Society score (KSS) on the first and seventh days after operation, changes in limb circumference before and after surgery and complications were compared among the three groups.Results All three groups of patients were followed up effectively.In terms of operation time and intraoperative blood loss, group B was better than group C, group C was better than group A, the difference was statistically significant (P <0.05).The difference in the perimeter of the affected limb (upper patella 20cm) before and after surgery, group A was better than group C, and group C was better than Group B, the difference was statistically significant (P <0.05).In terms of VAS scores on the 1st and 7th postoperative days, and KSS scores on the 1st and 7th postoperative days, group A and group C were better than group B, and the difference was statistically significant (P <0.05). there was no statistical significance between group A and group C (P > 0.05).Preoperative and postoperative hemoglobin difference,pre and postoperative hematocrit difference, pre and postoperative phosphocreatine kinase difference, and affected limb circumference (The difference between the upper and lower patella 10cm before and after surgery) and the postoperative complications were not statistically significant.Conclusion Staged tourniquet use during TKA surgery can effectively reduce the operation time and intraoperative hemorrhage, reduce postoperative limb pain and swelling, and promote the rehabilitation of joint function after TKA.