[1]周红星,易伟国,张保健,等.止血带在膝关节内侧间室骨关节炎初次单髁置换术中的应用[J].中医正骨,2019,31(04):31-35.
　ZHOU Hongxing,YI Weiguo,ZHANG Baojian,et al.Application of tourniquets to primary unicompartmental knee arthroplasty for treatment of medial compartment knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(04):31-35.
点击复制

止血带在膝关节内侧间室骨关节炎初次单髁置换术中的应用()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期数:
2019年04期
页码:
31-35
栏目:
临床研究
出版日期:
2019-04-30

文章信息/Info

Title:
Application of tourniquets to primary unicompartmental knee arthroplasty for treatment of medial compartment knee osteoarthritis
作者:
周红星; 易伟国; 张保健; 兰宇斌; 成小辉; 王永朝; 姜祖康; 袁祥生
(中国人民解放军第一五二中心医院,河南 平顶山 467000)
Author(s):
ZHOU Hongxing; YI Weiguo; ZHANG Baojian; LAN Yubin; CHENG Xiaohui; WANG Yongchao; JIANG Zukang; YUAN Xiangsheng
The 152nd Central Hospital of PLA,Pingdingshan 467000,Henan,China
关键词:
骨关节炎; 膝;  关节成形术; 置换; 膝;  止血带;  临床试验
Keywords:
osteoarthritis; knee;  arthroplasty; replacement; knee;  tourniquets;  clinical trial
摘要:
目的:观察止血带在膝关节内侧间室骨关节炎初次单髁置换术中的应用价值及安全性。方法:采用随机数字表将符合要求的90例膝关节内侧间室骨关节炎患者随机分为止血带组和无止血带组,每组45例。2组患者均行膝关节单髁置换术,术中止血带组大腿根部上气压止血带,无止血带组不上止血带。记录并比较2组患者的手术时间、膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国膝关节协会评分(knee society score,KSS)及并发症发生情况,并观察止血带组止血带反应发生情况。结果:①手术时间。止血带组的手术时间短于无止血带组[(61.00±3.24)min,(70.00±2.87)min,t=4.854,P=0.002]。②止血带反应。止血带组术中出现下肢疼痛3例、松止血带后血压下降38例,术后6 h出现下肢疼痛2例、大腿疼痛15例、下肢麻木17例、大腿根部张力性水疱1例,术后24 h出现大腿疼痛8例、下肢麻木2例、大腿根部张力性水疱8例,术后48 h出现大腿疼痛1例。③膝关节疼痛VAS评分。时间因素与分组因素不存在交互效应(F=23.846,P=0.170); 2组患者膝关节疼痛VAS评分比较,组间差异无统计学意义,即不存在分组效应(F=10.589,P=0.543); 手术前后不同时间点之间膝关节疼痛VAS评分的差异有统计学意义,即存在时间效应(F=14.286,P=0.000); 2组患者膝关节疼痛VAS评分随时间均呈降低趋势,且2组的降低趋势完全一致[(6.87±1.01)分,(6.14±1.21)分,(2.34±1.82)分,(1.96±1.34)分,(1.35±0.73)分,F=1.162,P=0.000;(7.03±1.24)分,(5.87±1.57)分,(2.41±1.65)分,(2.08±1.25)分,(1.24±0.68)分,F=8.023,P=0.000]。④KSS评分。时间因素与分组因素不存在交互效应(F=29.642,P=0.080); 2组患者KSS评分比较,组间差异无统计学意义,即不存在分组效应(F=15.637,P=0.642); 手术前后不同时间点之间KSS评分的差异有统计学意义,即存在时间效应(F=31.345,P=0.000); 2组患者KSS评分随时间均呈增加趋势,且2组的增加趋势完全一致[(35.4±4.61)分,(52.6±5.16)分,(73.7±4.81)分,(85.6±5.32)分,(89.2±4.29)分,F=34.284,P=0.000;(34.9±5.82)分,(51.4±4.85)分,(72.9±5.03)分,(84.9±4.86)分,(90.1±3.53)分,F=40.129,P=0.000]。⑤安全性。2组患者均无下肢深静脉血栓形成、假体组件移位、假体周围骨折等并发症发生。结论:在膝关节内侧间室骨关节炎初次单髁置换术中使用止血带,能缩短手术时间,并发症少,虽然术后会发生不同程度的止血带反应,但对膝关节疼痛缓解和膝关节功能恢复无明显影响。
Abstract:
Objective:To explore the applied values and safety of tourniquets in primary unicompartmental knee arthroplasty(UKA)for treatment of medial compartment knee osteoarthritis(KOA).Methods:Ninety patients with medial compartment KOA were enrolled in the study and were randomly divided into tourniquet group and non-tourniquet group by using random digits table,45 cases in each group.All patients in the 2 groups were treated with UKA,and the pneumatic tourniquets were applied to patients of tourniquet group at thigh root in the surgery,while no pneumatic tourniquets were applied to patients of non-tourniquet group.The operative time,knee pain visual analogue scale(VAS)scores,American knee society scores(KSS)and complications were recorded and compared between the 2 groups respectively,and the tourniquet reactions were observed in tourniquet group.Results:The operative time was shorter in tourniquet group compared to non-tourniquet group(61.00+/-3.24 vs 70.00+/-2.87 min,t=4.854,P=0.002).The lower limbs pain(3)and drop of blood pressure after releasing the tourniquet(38)were found during the surgery in patients of tourniquet group.The lower limbs pain(2),thigh pain(15),lower limb numbness(17)and tension blisters at the root of thigh(1)were found at postoperative hour 6.The thigh pain(8),lower limb numbness(2)and tension blisters at the root of thigh(8)were found at postoperative hour 24,and thigh pain(1)was found at postoperative hour 48.There was no interaction between time factor and group factor in knee pain VAS scores(F=23.846,P=0.170).There was no statistical difference in knee pain VAS scores between the 2 groups,in other words,there was no group effect(F=10.589,P=0.543).There was statistical difference in knee pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=14.286,P=0.000).The knee pain VAS scores presented a time-dependent decreasing trend in both of the 2 groups,and the 2 groups were consistent with each other in the decreasing trend of knee pain VAS scores(6.87+/-1.01,6.14+/-1.21,2.34+/-1.82,1.96+/-1.34,1.35+/-0.73 points,F=1.162,P=0.000; 7.03+/-1.24,5.87+/-1.57,2.41+/-1.65,2.08+/-1.25,1.24+/-0.68 points,F=8.023,P=0.000).There was no interaction between time factor and group factor in KSS scores(F=29.642,P=0.080).There was no statistical difference in KSS scores between the 2 groups,in other words,there was no group effect(F=15.637,P=0.642).There was statistical difference in KSS scores between different timepoints before and after the treatment,in other words,there was time effect(F=31.345,P=0.000).The KSS scores presented a time-dependent increasing trend in both of the 2 groups,and the 2 groups were consistent with each other in the increasing trend of KSS scores(35.4+/-4.61,52.6+/-5.16,73.7+/-4.81,85.6+/-5.32,89.2+/-4.29 points,F=34.284,P=0.000; 34.9+/-5.82,51.4+/-4.85,72.9+/-5.03,84.9+/-4.86,90.1+/-3.53 points,F=40.129,P=0.000).No complications such as lower extremity deep venous thrombosis,prosthetic components displacement and peri-prosthetic fracture were found in both of the 2 groups.Conclusion:Application of tourniquets can shorten the operation time in primary UKA for treatment of medial compartment KOA with few complications.Although tourniquet reactions at different degrees may occur after the surgery,they have no obvious effect on knee pain relief and knee function recovery.

参考文献/References:

[1] KRISTENSEN P W,HOLM H A,VARNUM C.Up to 10-year follow-up of the oxford medial partial knee arthroplasty-695 cases from a single institution[J].J Arthroplasty,2013,28(9 Suppl):195-198. [2] 周友龙,陈奇,康一凡,等.小切口单髁置换术治疗膝关节内侧间室骨性关节炎的早期疗效观察[J].中国骨与关节损伤杂志,2013,28(8):716-718. [3] MCALINDON T E,BANNURU R R,SULLIVAN M C,et al.OARSI guidelines for the non-surgical management of knee osteoarthritis[J].Osteoarthritis Cartilage,2014,22(3):363-388. [4] KHOKHAR A,CHARI A,MURRAY D,et al.Venous thromboembolism and its prophylaxis in elective knee arthroplasty:an international perspective[J].Knee,2013,20(3):170-176. [5] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123-124. [6] MARTIMBIANCO A L,CALABRESE F R,IHA L A,et al.Reliability of the “American Knee Society Score”(AKSS)[J].Acta Ortop Bras,2012,20(1):34-38. [7] 苏晓川,郭艳幸,滕军燕,等.平乐筋骨痛消膏外敷结合肌筋活化治疗膝骨关节炎[J].中医正骨,2017,29(11):58-59. 中医正骨2019年4月第31卷第4期 J Trad Chin Orthop Trauma,2019,Vol.31,No.4(总275) (总276)中医正骨2019年4月第31卷第4期 J Trad Chin Orthop Trauma,2019,Vol.31,No.4 [8] 陈煜东,魏瑄,刘宏建.单髁置换术治疗老年膝关节内侧间室骨关节炎[J].中医正骨,2018,30(6):67-69. [9] 郭马珑,崔宏勋,李峰,等.单髁置换术治疗中重度膝关节单间室骨关节炎[J].中医正骨,2017,29(6):16-19. [10] ZHANG Q D,GUO W S,ZHANG Q,et al.Comparison between closed suction drainage and nondrainage in total knee arthroplasty:a mata-analysis[J].J Arthroplasty,2011,26(8):1265-1276. [11] KRYCH A J,REARDON P,SOUSA P,et al.Unicompartmental knee arthroplasty provides higher activity and durability than Valgus-Producing proximal tibial osteotomy at 5 to 7 years[J].J Bone Joint Surg Am,2017,99(2):113-122. [12] 白玉明,张海森,刘畅,等.胫骨高位截骨术治疗单纯内侧间室膝骨关节炎术后炎性细胞因子水平变化研究[J].中国修复重建外科杂志,2017,31(4):422-426. [13] 崔黎明,李强.胫骨高位截骨结合关节镜治疗膝内侧骨关节炎[J].医学理论与实践,2015,28(16):2197-2198. [14] LIM J W,COUSINS G R,CLIFT B A,et al.Oxford unicompartmental knee arthroplasty versus age and gender matched total knee arthroplasty - functional outcome and survivorship analysis[J].J Arthroplasty,2014,29(9):1779-1783. [15] PANDIT H,JENKINS C,GILL H S,et al.Unnecessary contraindications for mobile-bearing unicompartmental knee replacement[J].J Bone Joint Surg Br,2011,93(5):622-628. [16] COSTA A J,LUSTIG S,SCHOLES C J,et al.Can tibial coverage in total knee replacement be reliably evaluated with three-dimensional image-based digital templating?[J].Bone Joint Res,2013,2(1):1-8. [17] 杨伟铭,曹学伟,赵彩琼.单髁置换术治疗膝关节内侧间室骨关节炎短期临床观察[J].中国中医骨伤科杂志,2018,26(4):40-44. [18] 杨伟铭,曹学伟.膝关节自发性骨坏死的研究进展[J].中国中医骨伤科杂志,2017,25(2):79-82. [19] HUANG Z Y,PEI F X,MA J,et al.Comparison of three different tourniquet application atrategies for minimally invasive total knee arthroplasty:a prospective non-randomized clinical trial[J].Arch Othop Trauma Sur,2014,134(4):561-570. [20] 王刚,曹晓瑞,陈晓勇,等.膝关节置换术中止血带的使用对术后加速康复的影响[J].中华骨与关节外科杂志,2017,10(1):27-32. [21] OSTMAN B,MICHAELSSON K,RAHME H,et al.Tourniquet-induced ischemia and reperfusion in human skeletal muscle[J].Clin Orthop Relat Res,2004,(418):260-265.

相似文献/References:

[1]樊庆阳,任凯晶.定制3D打印切模辅助全膝关节置换术治疗 膝骨关节炎合并股骨干骨折畸形愈合[J].中医正骨,2015,27(11):37.
[2]刘晓雅,孙永强,刘国杰.主动快速康复锻炼对全膝关节置换术后关节活动度的影响[J].中医正骨,2015,27(09):73.
[3]郑春松,叶蕻芝,李西海,等.透骨消痛胶囊中补肾柔肝药和活血祛风药治疗 骨关节炎作用方式的计算机模拟比较[J].中医正骨,2015,27(07):6.
　ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Comparison of the mode of action of Bushen Rougan(补肾柔肝)drugs versus Huoxue Qufeng(活血祛风)drugs contained in Tougu Xiaotong Jiaonang(透骨消痛胶囊)for the treatment of osteoarthritis:A computer simulation study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):6.
[4]宋兵华,孙俊英,倪增良,等.全膝关节置换术前CT测量股骨后髁角的临床意义[J].中医正骨,2015,27(07):38.
[5]郑春松,叶蕻芝,李西海,等.独活寄生汤含药血清对白细胞介素1β诱导的 退变关节软骨细胞中基质金属蛋白酶 和环氧化酶2表达的影响[J].中医正骨,2015,27(12):1.
　ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Impact of Duhuo Jisheng Tang(独活寄生汤)medicated serum on expression of matrix metalloproteinase and cyclooxygenase 2 in degenerative articular chondrocytes induced by interleukin-1 beta[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):1.
[6]王金良,孙京涛,李玲,等.骨水泥联合螺钉修复全膝关节置换术中 胫骨平台内侧骨缺损[J].中医正骨,2015,27(12):55.
[7]冯荣,王平,李炳奇,等.铍针刺络拔罐结合中药口服治疗膝骨关节炎合并 原发性血小板增多症1例[J].中医正骨,2015,27(12):73.
[8]蔡云仙.围手术期耳穴按压联合平衡针疗法 在全膝关节置换术后镇痛中的应用[J].中医正骨,2015,27(06):41.
[9]张荣,王健.人工全膝关节置换术的围手术期心理护理[J].中医正骨,2015,27(05):77.
[10]喻长纯,杨明路,王战朝.不同手术方式治疗胫骨平台骨折畸形愈合的体会[J].中医正骨,2015,27(03):37.
[11]孟维娜,明立功,王新德,等.关节镜下清理联合腓骨近1/3段截骨治疗膝骨关节炎[J].中医正骨,2015,27(11):40.
[12]明立功,孟维娜,王新德,等.腓骨近端截骨治疗内侧间室膝骨关节炎的近期疗效观察[J].中医正骨,2015,27(10):25.
[13]张杰,王人彦,张玉柱.膝骨关节炎的治疗进展[J].中医正骨,2015,27(10):68.
[14]梁朝,蔡静怡,闫立,等.针刀疗法改善膝骨关节炎早期疼痛症状的疗效评价[J].中医正骨,2015,27(09):9.
　LIANG Zhao,CAI Jingyi,YAN Li,et al.Evaluation of the curative effect of needle-knife therapy for relieving knee pain in patients with early knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):9.
[15]王建武,党建军,李强,等.四联疗法治疗膝骨关节炎[J].中医正骨,2015,27(08):44.
[16]刘红娟,郭会利,郭树农.云克联合中药治疗膝骨关节炎的护理[J].中医正骨,2015,27(08):75.
[17]陈卫衡.探索建立系统的膝骨关节炎中医临床科研范式 和理论体系[J].中医正骨,2015,27(07):1.
[18]帅波,沈霖,杨艳萍,等.加味青娥丸治疗膝骨关节炎的作用机制研究[J].中医正骨,2015,27(07):15.
　SHUAI Bo,SHEN Lin,YANG Yanping,et al.Study on the mechanism of action of Jiawei Qing'e Wan(加味青娥丸)for the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):15.
[19]梅其杰,袁长深,段戡,等.壮药骨痹方烫熨联合运动疗法治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(07):27.
　MEI Qijie,YUAN Changshen,DUAN Kan,et al.Clinical study of the curative effect of hot compressing and rubbing with packet of Gubi Fang(骨痹方)combined with exercise therapy in the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):27.
[20]王丹辉,张燕,刘丽娟,等.重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白 关节腔注射联合中药薰洗治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(07):31.
　WANG Danhui,ZHANG Yan,LIU Lijuan,et al.Clinical study on intra-articular injection of TypeⅡrecombinant human tumor necrosis factor receptor-Fc fusion protein combined with Chinese herbal steaming and washing therapy for treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):31.

备注/Memo

备注/Memo:
通讯作者:易伟国 E-mail:yiweigo2006@163.com(收稿日期:2018-12-02 本文编辑:时红磊)
更新日期/Last Update: 2019-10-08