中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (20): 3136-3142.doi: 10.3969/j.issn.2095-4344.1235

• 人工假体 artificial prosthesis • 上一篇    下一篇

个体化止血带压力在初次全膝关节置换中的应用

周建国1，胡伟全1，毕声荣1，胡碧娟2，刘世伟1，熊 龙3，钱 锐1   

  1. 赣州市人民医院，1关节外科，2超声科，江西省赣州市 341000；3江西省人民医院骨科，江西省南昌市 330006
  • 出版日期:2019-07-18 发布日期:2019-07-18
  • 通讯作者: 钱锐，主任医师，赣州市人民医院关节外科，江西省赣州市 341000
  • 作者简介:周建国，男，1984年生， 汉族，南昌大学医学院在读博士，主治医师，主要从事人工关节置换、创伤、运动医学与关节镜外科、显微修复重建外科临床与基础研究。
  • 基金资助:

    国家自然科学基金项目(81560355)，项目负责人：熊龙；江西省卫计委科技计划项目(20177236)，项目负责人：周建国；赣州市科技计划项目(GZ2017ZSF128)，项目负责人：周建国

Clinical application of individualized tourniquet pressure in primary total knee arthroplasty

Zhou Jianguo1, Hu Weiquan1, Bi Shengrong1, Hu Bijuan2, Liu Shiwei1, Xiong Long3, Qian Rui1   

  1. 1Department of Joint Surgery, 2Department of Ultrasound, Ganzhou People’s Hospital, Ganzhou 341000, Jiangxi Province, China; 3Department of Orthopedics, Jiangxi Provincial People’s Hospital, Nanchang 330006, Jiangxi Province, China
  • Online:2019-07-18 Published:2019-07-18
  • Contact: Qian Rui, Chief physician, Department of Joint Surgery, Ganzhou People’s Hospital, Ganzhou 341000, Jiangxi Province, China
  • About author:Zhou Jianguo, Doctoral candidate, Attending physician, Department of Joint Surgery, Ganzhou People’s Hospital, Ganzhou 341000, Jiangxi Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81560355 (to XL)| the Science and Technology Program of the Health Commission of Jiangxi Province, No. 20177236 (to ZJG)| the Science and Technology Program of Ganzhou, No. GZ2017ZSF128 (to ZJG)

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摘要：

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文题释义：
个体化止血带压力：止血带是一种相对简便的设备，可以有效的减少术中出血、为手术提供一个良好的视野、有利于骨水泥的使用及减少手术时间。但止血带常造成局部血管、肌肉、神经损伤，加重再灌注损伤、增加感染及隐性失血，延缓患者术后功能康复，且止血带损伤与其使用时间及压力有明显关系。选择腘动脉血流消失时肢体动脉阻断压为止血带压力，使充气压力更个性化，在保证术中止血效果的同时，减轻血管、肌肉、血管损伤，降低止血带相关并发症。
全膝关节置换：是一种治疗晚期膝关节骨性关节炎的常规技术，能非常有效地根除晚期膝关节病痛，改善膝关节功能，提高患者的生活质量；但其围术期出血量多，术后功能康复慢，而膝关节疼痛及肿胀是影响全膝关节置换术后早期快速康复的主要原因，有效采用止血带控制出血同时，同时快速有效的缓解膝关节疼痛及减轻肢体肿胀是促进全膝关节置换术后膝关节功能康复的重要措施。
 
摘要
背景：全膝关节置换是关节外科的常规手术方式，止血带已广泛应用于全膝关节置换术中，但如何选择合适的下肢止血带压力尚无统一的认识。选择合适的个体化止血带压力是否有助于全膝关节置换患者的加速康复尚需进一步研究。
目的：探讨个体化止血带压力在初次全膝关节置换中的临床疗效及并发症。
方法：纳入100例初次接受单侧全膝关节置换的膝关节骨关节炎患者，随机分为2组，每组50例。全膝关节置换手术全程使用止血带，试验组在彩超监视下确定肢体动脉阻断压为止血带压力，对照组选择70 kPa为止血带压力。2组患者对治疗方案均知情同意，且得到医院伦理委员会批准。记录2组患者术中失血量、术后引流量、隐性失血量、总失血量及深静脉血栓发生情况；比较2组患者术后第1，3，5天目测类比评分、膝关节活动度、下肢肿胀情况及术后1个月美国特种外科医院膝关节评分。
结果与结论：①试验组术后第1，3天休息时及活动时目测类比评分、术后第5天活动时目测类比评分低于对照组(P < 0.05)，2组术后第5天休息时膝关节目测类比评分差异无显著性意义(P > 0.05)；②试验组术后第1，3天下肢肿胀轻于对照组(P < 0.05)，2组术后第5天下肢肿胀差异无显著性意义(P > 0.05)；③2组术后第1，3，5天膝关节主动活动度差异无显著性意义(P > 0.05)；④2组术后1个月美国特种外科医院膝关节评分、术中失血量、术后引流量、隐性失血量及总失血量差异均无显著性意义(P > 0.05)；⑤提示采用彩超辅助下个体化止血带压力有助于减轻初次全膝关节置换患者术后早期疼痛及下肢肿胀，加速患者康复。

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
ORCID: 0000-0001-6651-2701(周建国)

关键词: 全膝关节置换, 止血带, 个体化止血带压力, 肢体动脉阻断压, 彩超, 深静脉血栓, 失血量, 下肢肿胀, 国家自然科学基金

Abstract:

BACKGROUND: Total knee arthroplasty is a routine surgical procedure for joint surgery. Tourniquet has been widely used in total knee arthroplasty. However, there is no unified understanding of how to select the appropriate tourniquet pressure, and whether the selection of appropriate individual tourniquet pressure is helpful to the enhanced rehabilitation of patients undergoing total knee arthroplasty needs further investigation.

OBEJCTIVE: To investigate the clinical efficiency and complications of individualized tourniquet pressure in patients undergoing primary total knee arthroplasty.
METHODS: One hundred patients with primary unilateral total knee arthroplasty were enrolled and randomly divided into trial and control groups, 50 in each group. The limb occlusion pressure was determined as tourniquet pressure by Doppler ultrasound in the trial group, while 70 kPa pressure was chosen as tourniquet pressure in the control group. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. The intraoperative blood loss, postoperative drainage volume, hidden blood loss, total blood loss and the incidence of deep venous thrombosis were recorded. The Visual Analogue Scale score, range of motion of knee joint and lower extremity swelling at 1, 3 and 5 days after surgery, and the Hospital for Special Surgery score at 1 month after surgery were compared.
RESULTS AND CONCLUSION: (1) The Visual Analogue Scale scores at rest and in activity at 1 and 3 days after surgery and in activity at 5 days after surgery in the trial group were significantly lower than those in the control group (P < 0.05). There was no significant difference in the Visual Analogue Scale scores at rest at 5 days after surgery between two groups (P > 0.05). (2) The lower extremity swelling at 1 and 3 days after surgery in the trial group was significantly lighter than that in the control group (P < 0.05), and there was no significant difference at 5 days after surgery between two groups (P > 0.05). (3) There was no significant difference in the range of motion of knee joint at 1, 3, and 5 days after surgery between two groups (P > 0.05). (4) There was no significant difference in the Hospital for Special Surgery score, intraoperative blood loss, postoperative drainage volume, hidden blood loss and total blood loss at 1 month after surgery between two groups (P > 0.05). (5) These results indicate that the individualized tourniquet pressure assisted by Doppler ultrasound contributes to relieving early pain and lower extremity swelling after primary total knee arthroplasty, and can accelerate the functional recovery.

Key words: total knee arthroplasty, tourniquet, individualized tourniquet pressure, limb occlusion pressure, Doppler ultrasound, deep venous thrombosis, blood loss, lower extremity swelling, the National Natural Science Foundation of China

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