驱血止血弹性束紧套环在初次全膝关节置换术中应用的疗效

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Abstract Objective To compare the clinical efficacy on the accelerated recovery of postoperative patients in Primary TKA with pneumatic tourniquet and a sterile exsanguination silicone tourniquet.Methods In total 50 patients undergoing primary total knee arthroplasty were retrospectively studied from April to October in 2020.With the design of sequential trial，in total 25 patients (20 cases of single knee，5 cases of double knee，a total of 30 knees) qualified were assigned to group sterile exsanguination silicone tourniquet from April to July；total 27 patients (24 cases of single knee，3 cases of double knees，a total of 30 knees) were included into the group of pneumatic tourniquets.Intraoperative blood loss before releasing tourniquet，total blood loss，surgical time，tourniquet use time，allogeneic blood transfusion rates，incidence of deep venous thrombosis and knee active range of motion (ROM) were summarized.Visual clarity of surgical field，thigh pain and knee pain were measured by the Visual Analog Scale.Lovett muscle strength classification standard was adopted to evaluate quadriceps strength.Results Compared to pneumatic tourniquet，the sterile exsanguination silicone tourniquet group could obviously decrease the blood loss before releasing tourniquet (P＜0.01).Meanwhile，the excellent visual clarity of surgery field could be acquired in sterile exsanguination silicone tourniquet group with Score (P＜0.01).However，there is no significant difference in total blood loss between the two groups (P＝0.67).In sterile exsanguination silicone tourniquet group，tourniquet use time (64.10±4.98) min，operation time (73.03±6.11) min，the incidence of deep vein thrombosis was 13.33%.In pneumatic tourniquet group，tourniquet use time (70.73±13.13) min，operation time (79.33±14.57) min，the incidence of deep vein thrombosis was 36.67%.The difference between the two groups was statistically significant (P＝0.01，P＝0.04，P＝0.04).In the postoperative early stage，the thigh VAS score，knee VAS score，quadriceps strength and knee active range of motion in sterile exsanguination silicone tourniquet group were much better than those in pneumatic tourniquet group.There was no significant difference for allogeneic blood transfusion rates and tramadol demand rate between groups.Conclusion A sterile exsanguination silicone tourniquet is an effective method to reduce intraoperative blood loss and provide much visual clarity of surgery field，which is beneficial to improve surgical efficiency and decrease tourniquet use time and and surgical time.In the postoperative early stage，compared to pneumatic tourniquet，sterile exsanguination silicone tourniquet could reduce the crush injury and thigh pain of tourniquet，improve quadriceps strength and knee active range of motion，which is beneficial to faster recovery for patient as well as increasing patient satisfactions.

Key words： total knee arthroplasty sterile exsanguination silicone tourniquet pneumatic tourniquet

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[1]	. [J]. sygkzz, 2021, 27(4): 366-370.