中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (27): 4327-4332.doi: 10.12307/2021.191

• 人工假体 artificial prosthesis • 上一篇    下一篇

全膝关节置换前半程使用止血带不会影响置换后功能性结果及疼痛：前瞻性随机对照试验

胡守业，杨  治，郝阳泉，鲁  超，张  琼，张伪松，朱玉杰，彭  侃   

  1. 西安交通大学附属红会医院骨坏死与关节重建病区，陕西省西安市   710054
  • 收稿日期:2020-08-11 修回日期:2020-12-26 接受日期:2020-10-24 出版日期:2021-09-28 发布日期:2021-04-10
  • 通讯作者: 彭侃，硕士，副主任医师，西安交通大学附属红会医院骨坏死与关节重建病区，陕西省西安市 710054
  • 作者简介:胡守业，男，1988年生，山东省菏泽市人，汉族，西安交通大学附属红会医院在读博士，主治医师，主要从事股骨头坏死、髋部、膝部相关疾病的发病机制研究、临床治疗及膝、髋人工关节置换临床应用方面的研究。
  • 基金资助:
    西安市科学技术局“科技+”行动计划-医学研究项目[20YXYJ0004(5)]，项目负责人：胡守业；陕西省科技技术厅自然科学青年基础项目(2020JQ-964)，项目负责人：胡守业

Tourniquet use in the first half-course of total knee arthroplasty does not affect postoperative functional outcomes or pain: a prospective, randomized controlled trial

Hu Shouye, Yang Zhi, Hao Yangquan, Lu Chao, Zhang Qiong, Zhang Weisong, Zhu Yujie, Peng Kan   

  1. Osteonecrosis and Joint Reconstruction Ward of Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • Received:2020-08-11 Revised:2020-12-26 Accepted:2020-10-24 Online:2021-09-28 Published:2021-04-10
  • Contact: Peng Kan, Master, Associate chief physician, Osteonecrosis and Joint Reconstruction Ward of Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • About author:Hu Shouye, Doctoral candidate, Attending physician, Osteonecrosis and Joint Reconstruction Ward of Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • Supported by:
    “Science and Technology +” Action Plan-Medical Research Project of Xi’an Science and Technology Bureau, No. 20YXYJ0004(5) (to HSY); Natural Science Youth Basic Project of Shaanxi Provincial Department of Science and Technology, No. 2020JQ-964 (to HSY)

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摘要：

文题释义：
全膝关节置换过程中使用止血带：在全膝关节置换过程中是否使用止血带存在争议。术中使用止血带能改善手术视野，降低失血量，并且改善假体的存活率(归因于骨水泥结合状态的改善)，然而止血带造成的问题包括缺血诱导的生理作用(尤其在使用时间延长的情况)、再住院率增加、疼痛及股四头肌功能恢复延迟等仍然困扰着临床医生。

背景：全膝关节置换术中是否使用止血带存在争议。
目的：观察全膝关节置换前半程使用(安装假体后释放)和不使用止血带对患者术后恢复的影响，探索全膝关节置换快速康复模式中止血带的更优使用策略。
方法：纳入200例行初次全膝关节置换的单侧膝关节骨关节炎患者，随机分配到前半程使用止血带组和不使用止血带组(n=100)。主要观察指标包括计时-起立-行走测试及目测类比评分、膝关节损伤及骨关节炎结果评分、健康调查12条简表评分，次要观察指标包括楼梯攀爬测试、失血量、手术时间、外科术野的可视性及关节活动度。在医院完成术前及术后指标检测，并在术后首次(术后四五周)及第二次随访(术后六七个月)完成随访指标检测。
结果与结论：①两组患者术后膝关节功能均较术前改善明显(P < 0.05)；②前半程使用止血带组患者术后住院期间大腿麻木发生率高(P < 0.05)，但围术期失血量更少(P < 0.001)，外科术野可视性更好(P < 0.001)；③首次随访，与不使用止血带组相比，前半程使用止血带组患者的膝关节伸展度更大(P=0.03)，膝关节损伤及骨关节炎结果评分中生活质量评分均值更高(P=0.03)；④二次随访，不使用止血带组患者爬楼梯速度更快，但两组之间差异无显著性意义(P=0.08)，其他评估结果组间差异均无显著性意义；⑤提示全膝关节置换术中前半程使用止血带能减少失血量，手术视野更好，尽管术后早期患者大腿麻木发生率高，但不会对功能恢复造成负面影响；这种止血带使用策略安全有效，更有利于快速康复的实施。
https://orcid.org/0000-0002-8724-2306 (胡守业) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 膝关节, 骨性关节炎, 全膝关节置换, 假体, 止血带, 快速康复

Abstract: BACKGROUND: Tourniquets use in total knee arthroplasty was highly controversial.  
OBJECTIVE: To optimize operative program in total knee arthroplasty by making a comparison on rehabilitation of postoperative patients between two strategies: front half (released after the prosthesis was placed) or no tourniquet use.
METHODS:  Two hundred patients with unilateral knee osteoarthritis were randomized to undergo total knee arthroplasty either with a tourniquet use in the first half-course (first half-course tourniquet group, 100 patients) or no tourniquet use (no tourniquet group, 100 patients). Primary outcome measures were functional assessment testing using the Timed Up & Go test and Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score, and 12-Item Short Form Health Survey scores. Secondary outcome measures included the stair-climb test, blood loss, operation time, surgical field visualization, and range of motion. Outcome measures were completed preoperatively, in the hospital, and postoperatively at a first (4 and 5 weeks postoperatively) and a second follow-up (6 and 7 months postoperatively).  
RESULTS AND CONCLUSION: (1) Postoperative knee joint function of both groups improved significantly compared with those before surgery (P < 0.05). (2) The incidence rate of thigh numbness of front-half tourniquet use group was higher during hospitalization (P < 0.05). However, average perioperative blood loss was less (P < 0.001) and visualized surgical field was wider (P < 0.001). (3) At first follow-up, knee joint extension degree was bigger (P=0.03) and the mean Knee Injury and Osteoarthritis Outcome Score associated with living quality were both higher in front-half tourniquet use group than those of no tourniquet use group (P=0.03). (4) At the second follow-up, although patients in the non-tourniquet use group climbed stairs faster, there was no statistical significance between the two groups (P=0.08). Other assessment results also presented no statistical difference between these two groups. (5) It is concluded that in spite of high incidence rate of thigh numbness which may not cause adverse effects, first half-course tourniquet use in total knee arthroplasty reduces blood loss and provides wider surgical field visualized. This strategy in total knee arthroplasty was safe and effective and can also advance the application of rapid recovery mode.

Key words: knee, osteoarthritis, total knee arthroplasty, prosthesis, tourniquet, enhanced recovery

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