全膝置换术止血带与控制性低血压的比较△

Comparison of tourniquet versus controlled hypotension in total knee arthroplasty

摘要:

[目的] 比较止血带与控制性低血压在全膝关节置换中应用的早期结果。[方法] 2022 年 9 月—2023 年 1 月 125 例膝骨性关节炎行单侧全膝关节置换患者纳入本研究。采用随机数字表分为两组，其中，60 例使用止血带 （TQ 组），65 例使用控制性低血压（CH 组）。比较两组早期临床及检验资料。[结果]两组患者均顺利完成手术，TQ 组术中失血量 [(60.2±12.7) ml vs (89.1±16.5) ml, P＜0.001] 显著少于 CH 组，但前者术后引流量 [(160.1±39.4) ml vs (128.0±37.5) ml, P＜0.001] 、隐性失血量 [(550.2± 277.7) ml vs (420.4±273.1) ml, P=0.009]、总失血量 [(770.5±275.1) ml vs (637.4±271.2) ml, P=0.007] 显著多于后者。两组术后膝关节 ROM 和 HSS 评分均显著增加（P＜0.05），术后 5 d 及 1 个月，TQ 组膝关节 ROM [(95.5±6.4)° vs (100.5±7.1)°, P＜0.001; (106.2±8.3)° vs (109.4±7.6)°, P=0.025] 和 HSS 评分 [(67.7±5.9) vs (72.3±6.9), P＜0.001; (81.1±4.6) vs (83.3±4.5), P=0.010 ] 均显著少于 CH 组。检验方面，两组患者术前 Hb、Hct、APTT、PT、Fib、D-D、CRP、IL-6 的差异均无统计学意义 （P＞0.05）。TQ 组术后第 1 d Hb、 Hct、APTT、PT 和术后第 3 d Hb、Hct、APTT 显著低于 CH 组 （P＜0.05），而术后第 1 d 前者的 D-D、CRP、IL-6 和术后第 3 d Fib、D-D、CRP、IL-6 均显著高于后者（P＜0.05）。[结论] 全膝置换采用控制性低血压可减少总失血量，缓解术后高凝状态， 减少炎症反应，促进膝关节功能的早期康复。

Abstract:

[Objective] To compare the early results of tourniquet versus controlled hypotension in total knee arthroplasty. [Methods] A total of 125 patients who underwent unilateral total knee arthroplasty for knee osteoarthritis from September 2022 to January 2023 were included in this study, and divided into two groups using the random number table method. Of them, 60 patients were treated with tourniquet (the TQ group), while other 65 patients were treated with controlled hypotension (the CH group). The early clinical and laboratory data of the two groups were compared. [Results] The operation was successfully completed in both groups. Although the TQ group had significantly lower intraoperative blood loss than the CH group [(60.2±12.7) ml vs (89.1±16.5) ml, P＜0.001], the former proved significantly greater than the latter in terms of postoperative drainage volume [(160.1±39.4) ml vs (128.0±37.5) ml, P＜0.001], latent blood loss [(550.2±277.7) ml vs (420.4±273.1) ml, P=0.009], total blood loss [(770.5±275.1) ml vs (637.4±271.2) ml, P=0.007]. The ROM and HSS scores significantly increased in both groups, 5 days and 1 month postoperatively compared with those preoperatively (P＜0.05). The TQ group was significantly inferior to the CH group in terms of knee ROM [(95.5±6.4)° vs (100.5±7.1)°, P＜0.001; (106.2±8.3)° vs (109.4±7.6)°, P=0.025] and HSS score [(67.7±5.9) vs (72.3±6.9), P＜0.001; (81.1±4.6) vs (83.3±4.5), P=0.010] 5 days and 1month postoperatively. As for laboratory test, there were no statistically significant differences in preoperative Hb, Hct, APTT, PT, Fib, D-D, CRP and IL-6 between the two groups (P＜0.05). The TQ group had significantly lower Hb, Hct, APTT, PT 1 day after surgery, Hb, Hct, APTT 3 days after surgery, whereas significantly higher DD, CRP, IL-6 one day and 3 days postoperatively than the CH group (P＜0.05). [Conclusion] Total knee arthroplasty under controlled hypotension does reduce total blood loss, relieve postoperative hypercoagulability, reduce inflammatory response, and promote early recovery of knee function.