膝单髁置换术止血带不同压力的比较△

Comparison of different pressures of tourniquet in unicompartmental knee arthroplasty

摘要:

[目的] 比较止血带不同压力策略在固定平台假体膝单髁置换术中应用效果。[方法] 采用前瞻性单盲随机对照研究2022 年7 月—2023 年7 月本院采用上述手术治疗的膝骨性关节炎的患者60 例，随机分为固定组、闭塞组、收缩压组，比较各组临床及检验。[结果] 三组患者均顺利完成手术，固定组止血带压力显著高于闭塞组和收缩压组[(300.0±0.0) mmHg vs (241.2±35.7) mmHg vs (273.1±12.3) mmHg, P＜0.001] ，但是，固定组止血带准备时间显著少于闭塞组和收缩压组[(0) min vs (3.9±0.8) min vs(1.5±0.5) min, P＜0.001] 。与术后第1 d 相比，术后第3、7 d 三组VAS 评分均显著减少（P＜0.05），HSS 评分显著增加（P＜0.05）。与术后第1 d 相比，术后第3 d 三组肿胀率显著增加（P＜0.05），术后7 d 肿胀率显著降低（P＜0.05）。固定组的术后相应时间点的VAS 评分和肿胀率，以及术后1、3 d 的HSS 评分均不及闭塞组和收缩压组，差异均有统计学意义（P＜0.05）。检验方面，与术前相比，术后2 d 三组的Hb 值均显著降低（P＜0.05），Hct 无显著变化（P＞0.05）。相应时间点，三组间Hb 值、Hct 的差异均无统计学意义（P＞0.05）。[结论] 固定平台假体膝单髁置换术中使用基于收缩压（systolic blood pressure, SBP） 和基于（limb occlusionpressure, LOP） 制定止血带压力的策略临床结果优于常规固定压力止血带。

Abstract:

[Objective] To compare the consequence of different pressure strategies of tourniquet in fixed bearing unicompartmentalknee arthroplasty (FB-UKA). [Methods] A prospective single-blind randomized controlled study was conducted on 60 patients who were un-dergoing FB-UKA for knee osteoarthritis in our hospital from July 2022 to July 2023. The patients were randomly divided into the fixed pres-sure(FP) group, limb occlusion pressure (LOP) group and systolic blood pressure (SBP) group, with 20 patients in each group. The clinicaland blood test data were compared among the 3 groups. [Results] All patients in the 3 group had FB-UKA performed successfully. The FPgroup had significantly higher tourniquet pressure than the LOP and SBP groups [(300.0±0.0) mmHg vs (241.2±35.7) mmHg vs (273.1±12.3)mmHg, P＜0.001], but the FP group consumed significantly less preparation time of tourniquet than that the LOP group and SBP group [(0)min vs (3.9±0.8) min vs (1.5±0.5) min, P＜0.001]. Compared with those 1 day after surgery, the VAS score significantly decreased (P＜0.05),whereas the HSS score significantly increased 3 days and 7 days after surgery in all the 3 groups (P＜0.05). Compared with that 1 day aftersurgery, the swelling rate of the three groups was significantly increased 3 days after surgery (P＜0.05), whereas which significantly decreased7 days after surgery (P＜0.05). The FP group proved significantly inferior to the LOP group and SBP group in terms of the VAS score andswelling rate at all corresponding time point after surgery, as well as HSS score 1 and 3 days after surgery, with significant differences (P＜0.05). Regarding blood test, the Hb decreased significantly (P＜0.05), while Hct remained unchanged significantly 2 days after surgery com-pared with those before surgery (P＞0.05). At any corresponding time points, there were no significant differences in Hb value and Hct amongthe three groups (P＞0.05). [Conclusion] The strategy of establishing tourniquet pressure based on systolic blood pressure (SBP) and limb oc-clusion pressure (LOP) does achieve more satisfactory outcomesthe than conventional fixed tourniquet pressure in FB-UKA.