减少全膝关节置换术围手术期出血的探讨

背景：全膝关节置换术（TKA）是关节外科失血较多的手术之一，如何有效降低TKA围手术期失血一直是关节外科医师研究的重点。 目的：通过术中选择性应用止血带及术后适当关闭引流管对TKA失血量的影响，探讨减少TKA围手术期失血量的方法。方法：2013年1月至2013年5月，因膝骨关节炎拟行单膝TKA患者53例，根据术中应用止血带方式及术后引流管开放形式分为两组。观察组30例，采用截骨完成后短期应用止血带联合术后早期夹闭4 h引流管；对照组23例，术中全程使用止血带及术后引流管处于自然开放引流状态。记录术中出血量及术后引流量，根据患者身高、体重和手术前后红细胞压积（Hct），通过Gross方程计算患者的总失血量，进而得出隐性失血量，记录两组术后输血的病例数，并计算平均输血单位，记录术后1、3、5 d的晨起体温，记录出院前后膝关节功能评分（HSS）。 结果：观察组的术中出血量明显多于对照组，术后引流量少于对照组，总出血量及隐性失血量少于对照组，均存在统计学差异（P＜0.05）；观察组的输血例数及平均输血单位均少于对照组；两组的围手术期晨起体温、膝关节HSS功能评分无统计学差异（P＞0.05）。 结论：采用截骨完成后短期应用止血带联合术后早期夹闭4 h引流管可明显减少TKA围手术期出血量。

How to reduce blood loss during total knee arthroplasty

Background： Total knee arthroplasty （TKA） is always associated with major bleeding volume. Therefore, how to reduce blood loss during TKA has been the focus of research for joint surgeon. Objective：To statistically analyze the effects of intraoperative selective application of tourniquet and appropriate postopera-tive drain clamping on blood loss of TKA. Methods：From January 2013 to May 2013, 53 patients with osteoarthritis underwent unilateral TKA and were divided into observation group （n=30） and control group （n=23）. In observation group, tourniquet was used in part-time intraoperatively, and the drain tube was clamped for 4 hours after surgery. In control group, tourniquet was used conventionally, while drain tube was not clamped postoperatively. Drain tubes were removed 48 hours after surgery in both groups. The bleeding vol-ume of the operation and wound drainage after surgery were recorded. Total blood loss was calculated according to Gross formula through height, body mass and pre-and post-operative hematocrit. Hidden blood loss was gotten by subtracting the visible blood loss from total loss. The cases of transfusion and the average units of transfusion were recorded. The average temperature in 1d, 3d, and 5d after surgery and the scores of knee joint function were also recorded. Results：Intraoperative blood loss in observation group was significantly more than that in control group, while wound drain-age, total blood loss and hidden blood loss, cases of transfusion and average units of transfusion in observation group were significantly less than those in control group （P〈0.05）. There were no significant differences in temperature and scores of knee joint function between two groups （P〉0.05）. Conclusions：The part-time application tourniquet during TKA and 4-hour clamping drainage after TKA can effectively de-crease the volume of bleeding.