Effect of tourniquet usage on rehabilitation after unicompartmental knee arthroplasty
GU Xu1 SUN Shaosong2 SHI Sifeng2 ZHENG Xin2 LU Renxiang1 CAO Jie1 LI Hongwei2
1.Graduate School, Xuzhou Medical University, Jiangsu Province, Xuzhou 221006, China;
2.Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Jiangsu Province, Xuzhou 221006, China
Abstract：Objective To investigate the effect of tourniquet usage on rehabilitation after unicompartmental knee arthroplasty. Methods A retrospective analysis was performed on 100 patients who received unicondylar replacement of knee joint in the Department of Joint Surgery, the Affiliated Hospital of Xuzhou Medical University from January to December 2021. According to the way of tourniquet application, the patients were divided into the whole course group of 33 cases, the second half group of 34 cases, and the non-tourniquet group of 33 cases. Operation time, blood loss, hemoglobin (Hb) and erythrocyte volume (Ht), thromboelasticity chart, visual analog scale (VAS) score, swelling rate of affected limb, American hospital for special surgery (HSS) score of knee joint and postoperative complications were recorded in the three groups. Results The swelling rate of the whole course group was higher than that of the second half group and non-tourniquet group (P＜0.05). At 24 h after surgery, Hb and Ht in the three groups were lower than before surgery, and the whole course group was higher than the second half of the course group and non- tourniquet group (P＜0.05). The VAS score of the whole course group was higher than that of the second half group and non-tourniquet group, the total blood loss and intraoperative blood loss were less than those of the second half group and non-tourniquet group, and the recessive blood loss was more than those of the second half group and non-tourniquet group (P＜0.05). The operation time of the whole course group and the second half group was shorter than that of the group without tourniquet (P＜0.05). The overall analysis showed that there were significant differences between groups and time points in HSS evaluation (P＜0.05). Further pairwise comparison and intra-group comparison: HSS scores of the three groups were compared at each time point, and the differences were statistically significant (P＜0.05). Comparison between groups: HSS score one month after operation in the whole course group was lower than that in the second half group and non-tourniquet group (P＜0.05). The overall analysis showed that there were significant differences among MA groups in comparison, time point comparison and interaction (P＜0.05). For further pairwise comparison, intra-group comparison showed that the MA of the whole group before surgery was lower than one day after surgery, and that of the whole group one day after surgery was higher than before surgery and seven days after surgery (P＜0.05). Comparison between groups: MA of the whole course group at seven days after surgery was higher than that of the second half group and non-tourniquet group (P＜0.05). There was no significant difference in the incidence of complications one month after operation among the three groups (P＞0.05). Conclusion The use of a tourniquet from the completion of osteotomy to the completion of suturing during unicompartmental knee replacement helps to reduce the effect on coagulation status, reduce postoperative pain and the degree of swelling of the affected limb, shorten the operative time, and promote functional recovery.
[1] 孟延丰，邹磊，王强，等.两种术式治疗膝骨关节炎的疗效及改善足底压力情况比较[J].临床骨科杂志，2022，25（3）：359-363.
[2] 边焱焱，程开源，常晓，等.2011至2019年中国人工髋膝关节置换手术量的初步统计与分析[J].中华骨科杂志，2020，40（21）：1453-1460.
[3] Wilson HA，Middleton R，Abram SGF，et al. Patient relevant outcomes of unicompartmental versus total knee replacement：systematic review and meta-analysis [J]. BMJ，2019， 364：l352.
[4] Xie J，Yu H，Wang F，et al. A comparison of thrombosis in total knee arthroplasty with and without a tourniquet：a meta-analysis of randomized controlled trials [J]. J Orthop Surg Res，2021，16（1）：408.
[5] Ahmed I，Chawla A，Underwood M，et al. Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery [J]. Bone Joint J，2021，（5）：830-839.
[6] 吴东，杨敏之，曹正，等.膝关节单髁置换术研究进展[J].中国修复重建外科杂志，2020，34（2）：145-150.
[7] 中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南（2018年版）[J].中华骨科杂志，2018，38（12）：705-715.
[8] Gross JB. Estimating allowable blood loss：corrected for dilution [J]. Anesthesiology，1983，58（3）：277-280.
[9] Jensen MP，Chen C，Brugger AM. Interpretation of visual analog scale ratings and change scores：a reanalysis of two clinical trials of postoperative pain [J]. J Pain，2003，4（7）：407-414.
[10] Insall JN，Ranawat CS，Aglietti P，et al. A comparison of four models of total knee-replacement prostheses [J]. J Bone Joint Surg Am，1976，58（6）：754-765.
[11] Cai DF，Fan QH，Zhong HH，et al. The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis：a meta-analysis [J]. J Orthop Surg Res，2019，14（1）：348.
[12] Smith TO，Hing CB. Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review [J]. The Knee，2010，17（2）：141-147.
[13] Arafah OM，Alotaibi AM，Alsalloum AM，et al. Safety and Blood Loss Associated With Tourniquets in Total Knee Arthroplasty [J]. Cureus，2021，13（8）：e16875.
[14] Wang K，Ni S，Li Z， et al. The effects of tourniquet use in total knee arthroplasty：a randomized，controlled trial [J]. Knee Surg Sports Traumatol Arthrosc，2017，25（9）：2849-2857.
[15] 杨健齐.不同膝关节屈曲角度对膝关节腔容积变化、患者舒适度及膝关节置换术后出血影响的实验研究[D].佛山：南方医科大学，2021.
[16] 曾立，闫冰，王永才，等.全膝关节置换术中应用止血带的meta分析[J].中国医药导报，2020，17（9）：69-72，86.
[17] 闫斌，哈斯鲁，买合木提·亚库甫，等.止血带致肢体缺血再灌注损伤时炎性递质变化及缺血预处理的作用[J]. 中国组织工程研究，2015，19（46）：7445-7450.
[18] Tsunoda K，Sonohata M，Kugisaki H，et al. The Effect of Air Tourniquet on Interleukin-6 Levels in Total Knee Arthroplasty [J]. Open Orthop J，2017，11：20-28.
[19] Dennis DA，Kittelson AJ，Yang CC，et al.Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function?A Randomized Trial [J]. Clin Orthop Relat Res，2016，474（1）：69-77.
[20] Jawhar A，Hermanns S，Ponelies N，et al. Tourniquet-induced ischaemia during total knee arthroplasty results in higher proteolytic activities within vastus medialis cells：a randomized clinical trial [J]. Knee Surg Sports Traumatol Arthrosc，2016，24（10）：3313-3321.
[21] Akpinar EE，Ho■gün D，Akan B，et al. Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery? [J]. J Bras Pneumol，2013，39（3）：280-286.
[22] Leurcharusmee P，Sawaddiruk P，Punjasawadwong Y，et al. The Possible Pathophysiological Outcomes and Mechanisms of Tourniquet-Induced Ischemia-Reperfusion Injury during Total Knee Arthroplasty [J]. Oxid Med Cell Longev，2018， 2018：8087598.
[23] Wang C，Liu Q，Sun L，et al.Application of thrombelastography in primary total knee and total hip replacement：a prospective 87 patients study [J]. Blood Coagul Fibrinolysis， 2019，30（6）：281-290.
[24] Gary JL，Schneider PS，Galpin M，et al. Can Thrombelastography Predict Venous Thromboembolic Events in Patients With Severe Extremity Trauma? [J]. J Orthop Trauma，2016，30（6）：294-298.
[25] Li X，Yin L，Chen ZY，et al. The effect of tourniquet use in total knee arthroplasty：grading the evidence through an updated meta-analysis of randomized，controlled trials [J]. Eur J Orthop Surg Traumatol，2014，24（6）：973-986.
京公网安备 11010502046598号