| Objective: This article explores the postoperative clinical effects ofapplying different methods of using a tourniquet for primary total kneearthroplasty（TKA),providing certain reference basis and clinicaldata forthe choosing of various use of tourniquets in TKA methoMethods: Based on a retrospective analysis of data of patients fromthe11th Floor of Orthopedics Dept. who underwent primary total kneearthroplasty （TKA）in No.3Hospital Affiliated to Jilin University betweenAugust2013and November2014, a total of80cases (80knees) withosteoarthritis whose data met the inclusion criteria were chosen. And theywere randomly divided into two groups.40patients from group A used atourniquet at the beginning of operation while the other40patients fromgroup B didn’t use a tourniquet until osteotomy was performed at tibia orfemur bone.Statistical data of the two groups involved in the research, as tothe patient’s body mass index, preoperative hemoglobin (Hb) level, redblood cell count (RBC), hematocrit (Hct), visual analogue scale (VAS) painand joint motion difference,had no statistical significance.(P>0.05)As wasshown in the table (1-4). Within24h after operation,the data werecompared between2groups of patients,including RBC, Hct, Hb,postoperative VAS of lateral knee pain, range of knee joint motion, lower extremity deep vein thrombosis, incidence of acute pulmonary embolism,hidden blood loss, dominant blood loss, theoretical total blood loss, rate ofblood transfusion, and postoperative both3d’ and7d’ VAS evaluationscores, as well as postoperative3d’,7d’ and3months’ range of knee jointmotion. Then SPSS17.0software is involved in doing related statisticalanalysis,with “t” as a continuous variable, using “x” as a classificationvariable to calculate the corresponding statistics and P values. P <0.05:It’sdeemed to be statistically significant between2groups. P>0.05:it’sdeemed to be no statistical significance.Results: There was no statistically significance in Hb, Hct andRBC between2groups within24hours after operation (P>0.05).Andthere was no statistically significant difference in theoretical total bloodloss between2groups (F=0.398,P=0.532>0.05)The dominant blood loss ofgroup A was significantly less than that of group B (P=0.013<0.05), whilethe hidden blood loss of group A was more than that of group B(P=0.027<0.05). There was statistical significant difference.3daysafter operation,the ROM values in group B were significantly larger thanthose of group A(F=8.312，P=0.016<0.05), but there was no statisticallysignificant difference5days,7days and3months after operation(P>0.05).10cases (25%) of group A and8cases of group B (20%) received bloodtransfusions with autologous or allogeneic blood and there was nostatistical significance (X2=0.287,P=0.790>0.05).The comparison of Hb, Hct, and RBC showed no statistically significant difference between2groups.Operation incisions of all patients were at a level of.“Ⅰ”.3daysafter operation,VAS score of Group B was better than that of group A (P=0.006<0.05)while there was no statistical significant difference in the VASscore7days after operation (P=0.914>0.05). The X-ray films showedthat the prosthesis was in good position, without loosening, subsidence,orosteolysis. After operation,4cases of thrombosis in group A appeared (calfmuscular venous thrombosis)while group B turned out to be3cases(Muscular venous thrombosis). No acute pulmonary embolismoccurred in2groups. And incidence of vein thrombosis had no statisticalsignificance（，P=0.905>0.05).Conclusion: Compared with using a tourniquet only when osteotomywas performed,the use of a tourniquet in TKA operation throughout thewhole process didn’t reduce blood transfusion. Although the latter reduceddominant blood loss it increased the hidden blood loss as well. Furthermore, the difference was not statistically significant in total blood loss.Therefore, it is recommended to reduce the time and pressure of atourniquet for patients with high-risk of thrombosis. |
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