| Background Inflatable tourniquet has be used in total knee arthroplasty (total knee arthroplasty, TKA) for more than30years. Easier to operate and more efficient to reduce intraoperative blooding, improve visualization and good bone-bone cement interface advantages and expedite surgical procedures. But at the same time there are a lot of complications, which is taken seriously by clinicians and there are disputes on the use of inflatable tourniquet in TKA.Objective To investigate the effects on the time of surgery, blood loss, coagulation function, joint function and muscle damage, limb ischemia reperfusion injury, postoperative pain, risk of thrombosis, infection, false body loose etc with treatment of tourniquet of different methods in simultaneous bilateral total knee arthroplasty.Methods The records of98patients on simultaneous bilateral total knee arthroplasty performed who were in line with the diagnostic criteria of osteoarthritis from October2009to October2011in the People’s Hospital of An’yang City were retrospectively reviewed.98patients with either right or left knee,196knees were then divided into group A total of98knees (48L+50R=98), tourniquet was used in whole surgery, group B total of98knees (50L+48R=98), tourniquet was only used in installation of the prosthesis, the tourniquet pressure set for65Kpa all hospitalized patients the next day preoperative routine examination, both lower extremities OK vascular Doppler ultrasound to rule out deep vein thrombosis and chronic venous disease, the day before surgery and postoperative30min,6h, Id,3d,7d,14d extract bilateral dorsal vein of foot serum D-dimer (D-dimer), creatine kinase (creatine kinas, CK), lactate dehydrogenase (lactate dehydrogenase, LDH) and platelet function indicators (PT, APTT, TT and FIB). Their hemoglobin and erythrocytes, drainage volume from knee lumen after operation, blood loss during operation, tourniquet-used time, total operation time and early variety of complications were recorded to compare the effect of tourniquet on blood loss, follow-up were observed after surgery at the time of14-day,3-month and6-month respectively, joint function of the HSS, Ji Bin ping joint function score, and complications. Two groups were compared the differences in operation time, tourniquet time, bleed loss, postoperative joint function and postoperative complications incidence. SPSS12.0statistical analysis, at different times repeated measurement data were compared using two-factor and multi-level analysis of variance between the two groups were compared using t-test, count data, percentages and rates were compared using the X2testResults1. No difference between two groups in gender, age, height, weight and ASA physical status (P=1), preoperative serum D-dimer, CK and LDH levels, and AT, APTT, FIB, TT was no difference (P=1), are comparable.2. Postoperative serum levels of D-dimer were significantly increased30min～6h, reached the peak, compared with group A significant difference (P<0.05); postoperative of CK and of LDH concentration of3-day were significantly higher, and A group differences were statistically significant (P<0.05); compared with group A after operation of APTT, TT at different time point were no significant difference (P>0.05), and were within the normal range (23～35S), two groups6h and1d after the TKA PT, FIB were increased, respectively, compared with the preoperative, there were significant differences (P<0.05), no difference between groups (P>0.05).3. No significant difference (P=0.865>0.05), With group A, operative time; tourniquet time was significantly different (P=0.000<0.05); the total volume of blood loss was statistically significant (P>0.05), Hb decline than the difference not statistically significant (P>0.05).4. Compared with group A the degree of the different times of joint activities14-day after significant difference (P<0.05), the rest of the time there was no significant difference (P>0.05), postoperative June joint activity tends to stable, the HSS score of the joint function of the different time there were no differences (P>0.05); the postoperative Ji Binping joint function score good rate after14-day were significantly different (P<0.05).5. And the group A comparison of lower extremity venous thrombosis and infection rates were statistically significant (P<0.05).6. Follow-up six months to two X-ray were not found in the loosening of the prosthesis.Conclusions1. To shorten tourniquet times can reduce the early postoperative hypercoagulable and the incidence of thrombosis and infection, and not extend the operation time and increase the total amount of bleeding in total knee arthroplasty.2. To shorten tourniquet times can reduce the direct damage of the local organization, limb ischemic injury, ischemia reperfusion injury and postoperative pain to be benefit of joint function early rehabilitation in total knee arthroplasty.3. To shorten tourniquet times can reduce the incidence of postoperative complications in total knee arthroplasty... |
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