| Background At present total knee arthroplasty (TKA) still is the most effective treatment for end-stage knee disease. Because of the TKA perioperative blood loss volume,the tourniquet is widely used in operation, can effectively control the intraoperative blood loss, to provide a good operative field, also may affect the postoperative recovery and the risk of complications, so the tourniquet application need to weigh the pros and cons. At present, the tourniquet in TKA using strategy has been widely studied, but who underwent TKA were elder patients mostly, the diversity of accompanied with internal chronic diseases. With obesity, hypertension, diabetes or preoperative long-term oral anticoagulant drug usually have an impact on the operation, and a tourniquet application effect in these different comorbidity crowd is not clear.Objective To investigat whether the use of a tourniquet affect TKA perioperative blood loss, postoperative recovery and complications in patients with different chronic comorbidity, so as to provide a reference for the strategies of using tourniquet in these different comorbidity crowd who underwent TKA.Methods 1. Included a total of 304 subjects according to whether underwent TKA with a tourniquet divided into tourniquet group (T-group,n=223) and without tourniquet group (NT-group,n=81),and analyze the differences between the 2 groups in Intraoperative blood loss, total blood loss, the hidden blood loss, blood transfusion, postoperative difference value of 5day hemoglobin(5dHb D-value), drainage, postoperative 3days motion pain visual analogue scale (VAS) score and thigh swelling rate, postoperative 3 weeks and 1 year KSS function score, and statistical postoperative complications.2. Screened research objects with obesity, hypertension, diabetes, and preoperative long-term oral anticoagulant drug users from all included subjects, in accordance with the same methods compared.Results 1. Total included 304 research subjects, preoperative 5dHb D-value, total blood loss, drainage volume had no significant difference between the two groups, but T-group Intraoperative blood loss was significantly lower than that in NT-group (P< 0.05), and hidden blood loss was significantly higher in T-group (P< 0.05). T-group postoperative 3days swelling and motion pain VAS score was significantly higher than that in NT-group (P< 0.05), Postoperative 3 weeks KSS function score was significantly lower than that in NT-group (P< 0.05),but 1 year after the operation there was no statistical difference. All postoperative without infection and prosthesis loosening occurred within 1 year,after operation total occurred in 5 cases of lower extremity deep venous thrombosis (DVT),23 cases of intermuscular venous thrombosis,14 cases of anemia,but postoperative major complications occurred rate had no significant difference between the two groups.2. Patients with obesity in 130 cases, accounted for 42.8%, The results are consistent with the research results in total subjects. Patients with hypertension in 105 cases, accounted for 34.5%, the total blood loss, blood transfusion in T-group were significantly lower than those in NT-group (P< 0.05). Patients with diabetes in 43 cases, accounted for 14.1%, the total blood loss, blood transfusion had no statistical significance between the two groups, but after the operation, occurred 2 cases DVT in T-tourniquet group, incidence rate of 6.4%. Patients with preoperative long-term oral anticoagulation in 61 cases, accounted for 20.1%, the total blood loss, blood transfusion in T-group were significantly lower than those in NT-group (P< 0.05). 3. The postoperative rehabilitation in every comorbidity crowd are almost consistent with the research results in total subjects, except Postoperative 3days thigh swelling rate were found no significant difference(P=0.155) between T-group and NT-group in the preoperative long-term oral anticoagulation patients.Conclusion Undergoing TKA, general use a tourniquet will reduce intraoperative blood loss, increased the postoperative hidden blood loss, result postoperative limb swelling and pain worse, early functional score lower, will not affect the perioperation total blood loss, functional recovery results after 1 year of operation and the incidence of postoperative complications. But in different comorbidity crowd will have different application effects, accompanied with obesity have the same effect with general, accompanied with hypertension or preoperative long-term anticoagulation therapy crowd using tourniquet can effectively reduce perioperative blood loss, accompanied with diabetes crowd using tourniquet may increase the incidence risk of postoperative DVT. So when undergoing TKA, need to choose appropriate tourniquet strategy according to the effect in different comorbidity crowd. |
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