闫昌葆;陈百成;赵宝辉;张建彬;董江涛;邢栋;康慧君;

• 1:河北医科大学第三医院关节骨科

摘要(Abstract)：

[目的]研究全膝关节表面置换术中止血带不同使用方法对术后早期患者临床症状及患肢功能的影响。[方法]采用随机对照研究方法,对40例骨性关节炎患者行单侧全膝关节表面置换术,其中20例应用全程止血带技术,20例应用中途止血带技术,通过比较两组的出血量、术后临床症状及功能的KSS评分等对2种止血带使用方法的早期临床效果加以评价。[结果]虽然2种止血带技术总的手术出血量差别不显著,但是应用中途止血带技术组患者术后出血量(581±263.9ml)少于全程止血带技术组(853±295.5ml),中途止血带组术后伤口红肿天数(3±1.1d)少于全程止血带组(8±1.3d),早期KSS临床评分中途止血带组(55.1±4.9)高于全程止血带组(43.3±5.4);功能评分中途止血带组(45.0±4.4)高于全程止血带组(32.5±8.5)。关节血肿发生率及下肢静脉血栓发生率差别不显著。[结论]全膝关节表面置换术中,应用中途止血带技术可以有效减少术后出血,明显改善术后早期临床症状及患肢功能。

关键词(KeyWords)： 全膝关节表面置换术;止血带;临床效果

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 闫昌葆;陈百成;赵宝辉;张建彬;董江涛;邢栋;康慧君;

Email:

DOI:

参考文献(References)：

• [1]Esler CN,Blakeway C,Fiddian NJ,et al.The use of a closed-suction drain in total knee arthroplasty.A prospective,randomised study[J].J Bone Joint Surg(Br),2003,85:215-217.
• [2]Prasad N,Padmanabhan V,Mullaji A,et al.Blood loss in total knee arthroplasty:an analysis of risk factors[J].Int Orthop,2006,5:134-137.
• [3]Ishii Y,Noguchi H,Matsuda Y,et al.A new tourniquet system that determines pressures in synchrony with systolic blood pressure in total knee arthroplasty[J].J Arthroplasty,2008,23:1050-1056.
• [4]李伟,夏仁云.止血带疼痛机制[J].中国矫形外科杂志,2000,7:59-61.
• [5]Thorey F,Stukenborg CC,Windhagen H,et al.The effect of tourni-quet release timing on perioperative blood loss in simultaneous bilat-eral cemented total knee arthroplasty:a prospective randomized study[J].Technol Health Care,2008,16:85-92.
• [6]王晓峰,陈百成.影响全膝关节置换术后膝关节活动度的因素[J].中国矫形外科杂志,2008,15:1156-1160.
• [7]Cheng YJ,Wang YP,Chen CT,et al.Small-dose propofol sedation at-tenuates the formation of reactive oxygen species in tourniquet-in-duced ischemia-reperfusion injury under spinal anesthesia[J].Anesth Analg,2002,94:1617-1620.
• [8]Sullivan PJ,Sweeney KJ,Hirpara KM,et al.Cyclical ischaemic pre-conditioning modulates the adaptive immune response in human limb ischaemia-reperfusion injury[J].J Surg(Br),2009,4:381-390.
• [9]张贵春,张向清.止血带及其副损伤[J].实用医药杂志,2003,20:65-67.
• [10]Alvarez JC,Santiveri FX,Ramos I,et al.Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conser-vation program is applied[J].Transfusion,2008,3:519-525.