| Objective: To evaluate the clinical efficacy of the two methods of the entire application of tourniquet,the drainage tube was placed after operation and limited application of tourniquet combined with tranexamic acid,drainage was not placed after the operation in reducing the perioperative blood loss of TKA through clinical retrospective controlled study,and provide reference for clinical work.Methods: This retrospective study involves 47 cases of complete unilateral total knee arthroplasty collected from the orthopaedics department of our hospital,from June2017 to December 2018.Conditions were matched in all cases.We divided them into two group according to the time sequence of treatment,one is the control group and the other is the experimental group.The control group including 29 cases.Inflated tourniquet was applied during the whole operation.The tranexamic acid was not given after the operation.The drainage tube was placed after operation.The experimental group including 18 cases.Intraoperative soft tissue hemorrhage was immediately stoped at first time.The inflated tourniquet was applied only when the osteotomy was to start till the prosthesis was installed.The tranexamic acid was injected into the joint cavity,and drainage was not placed after the operation.The amount of hemoglobin before and1 day,3 days,7 days after surgery,the degree of knee pain(VAS score),the healing of incision,and the blood transfusion status were recorded.The difference between preoperative and postoperative hemoglobin was calculated.And the comprehensive blood transfusion rate and other values,after statistical analysis to assess the difference between the two groups.The analysis was performed using SPSS 19 software.P<0.05 indicated that the difference was significant.Results: Statistical analysis: 1.The amount of hemoglobin before operation: There was no significant difference in the amount of hemoglobin between the experimental group and the control group(P>0.05).While the amount of hemoglobin 1 day,3 days,7days after operation in the experimental group was significantly higher than the control group(P<0.05).The difference in the amount of hemoglobin between the experimental group was significantly lower than that of the control group.2.VAS pain score: There was no statistically significant difference in the VAS pain score between theexperimental group and the control group(P>0.05);3.Flexion and extension range of motion of knee joint: in terms of range of motion,the experimental group was significantly higher than the group with the control group(P<0.05).4.transfusion and incision status:There was no transfusion in patients after the experimental group.There were three patients with blood transfusion in the control group and the total transfusion rate was 10.3%.In the whole process,2 patients in the control group were treated with delayed healing.The sutures were completely removed at 18 and 20 days after surgery.In one month after operation,the knife edge was completely healed and no obvious abnormalities were observed.There were no complications such as knife-edge infection,joint hematoma and thromboembolism in the experimental group and the control group.Conclusions: We cancluded that limited application of tourniquet combined with tranexamic acid,drainage was not placed after the operation compared to the entire application of tourniquet,the drainage tube was placed after operation is more advantageous in controlling the amount of perioperative blood loss.While there were no significant difference in operation time,the perioperative blood loss and postoperative blood transfusion rate can be effectively reduced due to sufficient intraoperative hemostasis and significantly reduced postoperative blood loss.Limited application of the tourniquet can reduce the incidence of complications such as ischemia-reperfusion injury,coagulation disfunction,nerve paralysis,tourniquet shock and other tourniquet complications,and promote the rapid recovery of patients. |
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