全膝关节置换术中使用止血带疗效与安全性的meta分析

目的 系统评价全膝关节置换术(TKA)中使用止血带疗效与安全性.方法 计算机检索Medline、PubMed、EMASE、Cochrane Library、中国生物医学文献数据库、Highwire、CNKI、VIP、万方数字期刊群,搜索国内外关于TKA中是否使用止血带的随机对照研究资料,采用RevMan 4.2.2软件进行meta分析.结果 纳入研究19篇,外文15篇,中文4篇,共计1159例膝关节置换术患者.meta 分析结果显示:TKA术中使用止血带与不使用止血带两组在术中失血量(P=0.000)、深静脉血栓(P=0.020)、大腿疼痛例数(P=0.000)、膝关节血肿例数(P=0.030)、切口感染例数(P=0.040)、皮肤淤斑面积(P＜0.000)、术后3 d膝关节周径增加率(P=0.000)方面差异有统计学意义,但在总失血量(P=0.100)、输血例数(P=0.150)、手术时间(P=0.120)、住院时间(P=0.350)、肺栓塞例数(P=0.310)、皮肤水泡例数(P=0.170)方面差异无统计学意义.结论 TKA中使用止血带能减少术中出血量,但并不减少总失血量与输血例数,不提高手术效率,不缩短住院时间,不促进术后膝关节功能恢复,且可能增加下肢深静脉血栓、切口感染、膝关节血肿与淤斑发生率,引起膝关节肿胀与大腿疼痛;建议在TKA中尽量少用止血带.

A meta-analysis for the efficacy and safety of tourniquet in total knee arthroplasty

Objective To evaluate the efficacy and safety of tourniquet in total knee arthroplasty.Method Studies on comparison between with and without tourniquet in total knee arthroplasty were identified from Medline, PubMed, EMASE, Cochrane Library, CBM, Highwire, CNKI, VIP, Articles Digital Periodicals. All the randomized controlled trials were included for meta-analysis with RevMan 4. 2. 2 software. Results Nineteen studies involving 15 in foreign languages, 4 in Chinese were identified. There were 1159 cases of knee replacement patients. The results of meta-analysis indicated that there were statistical difference between two groups on intraoperative blood loss ( P = 0. 000 ) , the number of deep venous thrombosis (P =0. 020) , thigh pain (P = 0. 000) , knee hematoma (P =0. 030) , wound infection (P =0. 040) , skin ecchymosis area (P =0. 000) , and the increasing rate of knee circumference of 3 days after the operation (P =0. 000) , while there were no statistical differences with respect to the total blood loss (P = 0. 100) , the number of blood transfusions ( P = 0. 150) , operation time ( P = 0. 120) , length of hospital stay (P = 0. 350) , the number of pulmonary embolism ( P = 0. 310) , and skin blisters (P =0. 170). Conclusions The tourniquet for total knee arthroplasty can reduce intraoperative blood loss, but can not reduce total blood loss and the number of blood transfusions transfusion, can not improve operative efficiency, can not shorten the hospitalization time and promote the knee joint functional recovery. Furthermore the tourniquet increases the probability of occurrence on deep vein thrombosis, wound infection, hematoma and ecchymosis knee, it also causes knee swelling and thigh pain. It suggests minimize to use tourniquet in total knee arthroplasty.