The effect of tourniquet use on operative performance and early postoperative results of anatomic double-bundle anterior cruciate ligament reconstruction
The effect of tourniquet use on operative performance and early postoperative results of anatomic double-bundle anterior cruciate ligament reconstruction
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DOI：
10.1007/s00776-013-0405-2
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发表时间：
2013-07-01
影响因子：
1.7
通讯作者：
Yoshiya, Shinichi
中科院分区：
文献类型：
--
作者：
Nakayama, Hiroshi;Yoshiya, Shinichi
本研究的目的是探讨止血带的使用对解剖双束前交叉韧带（ACL）重建手术性能和术后早期结果的影响。2010年6月至2011年10月，51例单侧前交叉韧带缺乏症患者接受了预定的前交叉韧带重建。手术时的平均年龄为26.3岁（14-45岁）。所有病例均采用自体腘绳肌腱移植行解剖束重建手术。将患者随机分为两组：止血带组（T组）和不止血带组（NT组）。T组28例患者使用止血带进行重建手术，而NT组23例患者仅在移植物收获期间充气止血带。两组的手术程序和术后处理相同。组间比较术中、围术期临床参数及术后早期结果（3个月功能恢复）。在手术过程中，即使没有使用止血带，关节镜视野也没有受到损害。两组手术时间比较，差异无统计学意义（P = 0.10）。T组经关节内引流管校正的血流量明显大于T组（P = 0.02），而以术后血红蛋白值降低计算的总失血量组间差异无统计学意义（P = 0.74）。T组术后麻木VAS评分明显高于对照组（P = 0.0002），但疼痛VAS评分差异无统计学意义（P = 0.30）。此外，3个月时肌肉力量的恢复在两组之间没有显著差异。这项比较研究表明，关节镜手术可以在不使用止血带的情况下顺利进行。不使用止血带时的临床参数无显著差异，但使用止血带导致术后关节内出血和VAS麻木增加。前瞻性随机研究，II级。
The purpose of this study was to examine the effect of tourniquet use on operative performance and early postoperative results of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction.Fifty-one patients who underwent scheduled ACL reconstruction for unilateral ACL deficiency from June 2010 to October 2011 were included in this study. The mean age at surgery was 26.3 years (range 14-45 years). An anatomic bundle reconstructive procedure with an autogenous hamstring tendon graft was performed in all cases. These patients were randomly divided into two groups: the tourniquet group (T group) and no tourniquet group (NT group). The reconstructive procedure was performed with the use of a tourniquet for 28 patients in the T group, while a tourniquet was inflated only during the graft harvest for 23 patients in the NT group. The surgical procedure and postoperative management were identical for both groups. Inter-group comparison was conducted for intra- and peri-operative clinical parameters as well as early postoperative results (functional recovery at 3 months).The arthroscopic visual field during the procedure was not compromised even without the use of a tourniquet. There was no significant difference in operative time between the groups (P = 0.10). The amount of blood corrected through the intraarticular drain was significantly larger in the T group (P = 0.02), while total blood loss calculated by the postoperative reduction of the hemoglobin value was not significantly different between the groups (P = 0.74). Although the VAS value for postoperative numbness was significantly higher in the T group (P = 0.0002), the VAS value for pain was not significantly different (P = 0.30). Additionally, recovery of muscle strength at 3 months was not significantly different between the groups.This comparative study showed that arthroscopic procedures could be uneventfully performed without the use of a tourniquet. The clinical parameters when not using a tourniquet were not significantly different, but the use of a tourniquet resulted in an increase in postoperative intraarticular bleeding and VAS for numbness.Prospective randomized study, Level II.