控制性降压对全膝关节置换术血液丢失及骨水泥渗透厚度的影响

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Abstract Objective To compare the blood loss and bone cement penetration thickness after total knee arthroplasty under controlled hypotension and tourniquet.Methods retrospective study was conducted to collect 168 patients in the Fuyang Hospital Affiliated to Bengbu Medical College.The patients underwent unilateral total knee arthroplasty under general anesthesia from January 2020 to December 2022.According to different methods of intraoperative hemostasis，they were divided into a controlled hypotension group and a tourniquet group.The controlled hypotension group had 61 cases.Among them，there were 17 males and 44 females.The patients aged 55 to 80 years，with an average age of (67.26±5.56)years.The tourniquet group had 107 cases.Among them，there were 28 males and 79 females.The patients aged 55~80 years，with an average age of (67.70±5.81)years.There was no statistically significant difference between the two groups in general information such as gender，age，height，weight，body mass index，and preoperative hemoglobin and hematocrit (P＞0.05).The differences in blood loss data，surgical time，and bone cement infiltration thickness around the tibial prosthesis were compared between the two groups. Results There was no statistically significant difference between the two groups in surgical time，dominant blood loss，and bone cement infiltration thickness around the tibial prosthesis (P＞0.05).There was a statistically significant difference between the two groups in hemoglobin reduction，hematocrit reduction，intraoperative bleeding，postoperative drainage，hidden blood loss，and total blood loss (P＜0.05).Conclusion Compared to using a tourniquet during surgery，the use of controlled hypotension can reduce the patient’s hidden blood loss and total blood loss，without increasing the surgical duration，and without affecting the bone cement penetration thickness around the tibial prosthesis in total knee arthroplasty.

Key words： total knee arthroplasty controlled hypotension tourniquet blood loss penetration thickness of bone cement

Corresponding Authors: Wang Hongliang

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	Li Xinglong
	Liu Jiawei
	Cheng Jianjun
	Ding Ya
	Cai Ning
	Yu Haiyang
	Wang Hongliang

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Li Xinglong,Liu Jiawei,Cheng Jianjun, et al. Effects of Controlled Hypotension on Blood Loss and Bone Cement Penetration Thickness in Total Knee Arthroplasty[J]. sygkzz, 2023, 29(11): 970-.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2023/V29/I11/970

［1］王波，余楠生.膝骨关节炎阶梯治疗专家共识(2018年版)［J］.中华关节外科杂志(电子版)，2019，13(1)：124-130.
［2］Jawhar A，Skeirek D，Stetzelberger V，et al.Influence of the tourniquet on pain and function in total knee arthroplasty：A systematic review and meta-analysis［J］.Z Orthop Unfall，2020，158(6)：630-640.
［3］Zhao HY，Yeersheng R，Kang XW，et al.The effect of tourniquet uses on total blood loss，early function，and pain after primary total knee arthroplasty：A prospective，randomized controlled trial［J］.Bone Joint Res，2020，9(6)：322-332.
［4］张子琦，梁佳林，左小莉，等.气压止血带对人工全膝关节置换术围术期失血量的影响［J］.中国修复重建外科杂志，2019，33(6)：681-684.
［5］Liu Y，Si H，Zeng Y，et al.More pain and slower functional recovery when a tourniquet is used during total knee arthroplasty［J］.Knee Surg Sports Traumatol Arthrosc，2020，28(6)：1842-1860.
［6］Jawhar A，Brenner D，De La Torre C，et al.Gene expression analysis of vastus medialis cells after tourniquet-induced ischemia during total knee arthroplasty：A randomized clinical trial［J］.Eur J Trauma Emerg Surg，2021，47(1)：233-240.
［7］Shetty T，Nguyen JT，Sasaki M，et al.Risk factors for acute nerve injury after total knee arthroplasty［J］.Muscle Nerve，2018，57(6)：946-950.
［8］宋敏，卢超，陈锦，等.全膝关节置换过程中应用止血带对骨水泥渗透厚度影响的Meta分析［J］.中国组织工程研究，2021，25(12)：1917-1923.
［9］Eckenhoff JE，Rich JC.Clinical experiences with deliberate hypotension［J］.Anesth Analg，1966，45(1)：21-28.
［10］Ma RX，Qiao RQ，Xu MY，et al.Application of controlled hypotension during surgery for spinal metastasis［J］.Technol Cancer Res Treat，2022(21)：15330338221105718.
［11］Riedel K，Thudium M，Bostr-m A，et al.Controlled arterial hypotension during resection of cerebral arteriovenous malformations［J］.BMC Neurol，2021，21(1)：339.
［12］余柔，刘进.控制性降压在全髋、膝关节置换术中有效性和安全性的Meta分析［J］.中国循证医学杂志，2021，21(1)：40-46.
［13］童培建.髋膝关节置换围手术期加速康复专家共识［J］.实用骨科杂志，2021，27(11)：961-965.
［14］Nadler SB，Hidalgo JH，Bloch T.Prediction of blood volume in normal human adults［J］.Surgery，1962，51(2)：224-232.
［15］Gross JB.Estimating allowable blood loss：Corrected for dilution［J］.Anesthesiology，1983，58(3)：277-280.
［16］Lands VW，Malige A，Carmona A，et al.Reducing hypotension and acute kidney injury in the elective total joint arthroplasty population：A multi-disciplinary approach［J］.J Arthroplasty，2018，33(6)：1686-1692.
［17］Walsh M，Devereaux PJ，Garg AX，et al.Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery：Toward an empirical definition of hypotension［J］.Anesthesiology，2013，119(3)：507-515.
［18］刘克，徐伟民，林泉，等.控制性降压在全麻下膝关节置换中的应用［J］.中国矫形外科杂志，2021，29(16)：1446-1450.
［19］Lieberman JR，Huo MM，Hanway J，et al.The prevalence of deep venous thrombosis after total hip arthroplasty with hypotensive epidural anesthesia［J］.J Bone Joint Surg (Am)，1994，76(3)：341-348.
［20］Wang HY，Yuan MC，Pei FX，et al.Finding the optimal control level of intraoperative blood pressure in no tourniquet primary total knee arthroplasty combine with tranexamic acid：A retrospective cohort study which supports the enhanced recovery strategy［J］.J Orthop Surg Res，2020，15(1)：350.
［21］Lai YH，Xu H，Su Q，et al.Effect of tourniquet use on blood loss，pain，functional recovery，and complications in robot-assisted total knee arthroplasty：A prospective，doubleblinded，randomized controlled trial［J］.J Orthop Surg Res，2022，17(1)：118.
［22］Moo IH，Chen JYQ，Pagkaliwaga EH，et al.Bone wax is effective in reducing blood loss after total knee arthroplasty［J］.J Arthroplasty，2017，32(5)：1483-1487.
［23］Jeon YS，Park JS，Kim MK.Optimal release timing of temporary drain clamping after total knee arthroplasty［J］.J Orthop Surg Res，2017，12(1)：47.
［24］邓立庆，李嘉，田臻，等.无止血带下全膝关节置换术后切口非加压包扎的临床效果评价［J］.实用骨科杂志，2021，27(8)：744-748.
［25］汪萧和，王志文，陆鸣，等.两种止血带使用方式对150例全膝关节置换术患者失血量和术后康复影响的前瞻性随机对照研究［J］.中华骨与关节外科杂志，2020，13(9)：736-740.
［26］袁铭成，丁子川，陵廷贤，等.人工全髋、膝关节置换术围术期血液管理［J］.中国修复重建外科杂志，2020，34(12)：1612-1618.
［27］Sun C，Yang X，Zhang X，et al.The impact of tourniquet on tibial bone cement penetration in different zones in primary total knee arthroplasty：A metaanalysis［J］.J Orthop Surg Res，2021，16(1)：198.
［28］高平，李会波，白正武，等.TKA术中不使用止血带对早期假体稳定性及膝关节功能的影响［J］.中国骨与关节损伤杂志，2019，34(12)：1294-1296.
［29］Scheele CB，Pietschmann MF，Schr-der C，et al.Effect of bone density and cement morphology on biomechanical stability of tibial unicompartmental knee arthroplasty［J］.Knee，2020，27(2)：587-597.
［30］Billi F，Kavanaugh A，Schmalzried H，et al.Techniques for improving the initial strength of the tibial tray-cement interface bond［J］.Bone Joint J，2019，101-B(1 Supple A)：53-58.
［31］Hegde V，Bracey DN，Johnson RM，et al.Tourniquet use improves cement penetration and reduces radiolucent line progression at 5 years after total knee arthroplasty［J］.J Arthroplasty，2021，36(7S)：S209-S214.
［32］钟齐刚，冯茹，叶厚龙，等.是否使用止血带全膝置换术的中期随访比较［J］.中国矫形外科杂志，2021，29(23)：2113-2117.

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