止血带在骨折内固定术中的应用探讨

目的 探讨止血带在胫骨髓内钉内固定术中的应用价值及并发症.方法 将46例骨科胫腓骨骨折患者随即分成两组(止血带组和对照组),对照组采用膝关节过屈的方法预防出血,止血带组采用止血带止血.观察两组手术时间、出血量、下肢周径差值、下肢体积差值、足背皮肤有无麻木感觉、拇趾可否背伸并进行比较分析.结果 止血带组、对照组手术时间分别为(58±13)min、(61±11)min,术中出血量分别为(66±22)ml、(73±18)ml,两组比较差异均无统计学意义(均P>0.05);止血带组、对照组术后小腿周径差值分别为(3.6±0.5)cm、(1.8±0.4)cm,术后下肢体积差值分别为(986±32)cm3、(758±33)cm3,两组比较差异有统计学意义(P<0.05);止血带组术后有3例足背皮肤感觉麻木、术后拇趾背伸肌力下降,对照组无类似手术并发症发生,两组比较,差异有统计学意义(P<0.05).结论 骨折内固定术中使用止血带能加重术后下肢肿胀程度,较易并发患肢神经损伤,不能缩短手术时间及减少术中出血量,不提倡常规使用.

Application value of tourniquet in intramedullary nailing for the treatment of tibial fractures.

Objective The purpose of this study was to evaluate the application value of tourniquet in intr-amedullary nailing for the treatment of tibial fractures. Methods A randomized controlled trial was conducted. A total of 46 patients(31 males and 15 females)were selected. The patients were assigned to both groups:tourniquet group and control group. The primary observational indexes were the surgery time,the volume of blood loss,lower limb swell-ing,hypoesthesia of dorsum pedis and myodynamia of lower limb. Results The surgery time of tourniquet group and control group were(58±13)min(61±11)min,the volume of blood loss were(66±22)ml(73±18) ml,There were no significanle(P>0.05 ). The diameter discrepancy of lower limb of tourniquet group and control group were( 3.6±0.5) cm、(1.8±0.4) cm, the volume discrepancy of lower limb were (986±32) era3 ( 758± 33 ) cm3. There were sig-nificant difference(P<0.05). There were hypoesthesia of dorsum pedis and myodynamia of lower limb in 3 cases of the tourniquet group and no similar complications in control group. There were significant differences ( P<0.05 ).Conclusion The usage of the tourniquet in intramedullary nailing for the treatment of tibial fractures couldn't reduce the surgery time and the volume of blood loss during intramedullary nailing,meanwhile,it could increase the risk of side effects after operation. It isn't necessary for the treatment of tibial fractures.