نویسندگان
جراح متخصص ارتوپدی،دانشگاه علوم پزشکی تبریز، تبریز، ایران.
چکیده
چکیده
پیشگفتار: استفاده از تورنیکت در تعویض کامل مفصل زانو TKA1 توسط بسیاری از جراحان توصیه می‌شود. با این حال؛ شواهد مبنی بر تأثیرگذاری آن در کاربرد این جراحی در هاله‌ای از ابهام قراردارد. ما تأثیر استفاده از تورنیکت را در کاهش خونریزی و میزان نیاز به انتقال خون در جراحی TKA ارزیابی کردیم.
مواد و روش‌ها: بیماران مراجعه کننده به دو بیمارستان در تبریز برای انجام عمل جراحی TKA در یک دورة یک‌ساله «مورد – کنترل» بررسی و در این مطالعه قرار گرفتند. 8 بیمار مرد و 23 زن از نظر استفاده از تورنیکت در طول عمل جراحی TKA به دو گروه تقسیم شدند: در گروه اول، تورنیکت از ابتدای جراحی تا اتمام سفت شدن سیمان باد شده بود و در گروه دوم، این اقدام قبل از مرحله شروع سیمان‌گذاری و تا سخت شدن سیمان رخ داده بود. همة این مراحل توسط یک جراح منفرد، با تکنیک یکسان و تحت بی‌حسی ناحیه‌ای، با مصرف مادة ترومبولیتیک یکسان و پیشگیری از عفونت انجام شد. افت سطح هموگلوبین در روز اول بعد از جراحی، اندازه‌گیری و با سطح قبل از عمل در دو گروه، مقایسه شد. نیاز به تزریق خون نیز بین دو گروه، مورد بررسی و مقایسه قرار گرفت.
نتایج: 23 بیمار (2/74%) نیاز به تزریق خون نداشتند و این در حالی بود که 8 مورد آنها (8/25%) نیاز به تزریق و انتقال خون داشتند. گروه بدون تورنیکت ۴ مورد و گروه با تورنیکت ۴ مورد به گرفتن خون نیاز داشتند. میانگین مدت زمان جراحی
3/26±81/75 دقیقه بود. میانگین سطح HB قبل از عمل، 67/1±66/12 بود که بعد از عمل 62/1±09/11 به دست آمد. اختلاف میزان هموگلوبین قبل و بعد از عمل در گروه بدون تورنیکت 36/1 و با تورنیکت 96/1 بود.
نتیجه‌گیری: اگرچه استفاده از تورنیکت مدت زمان این عمل جراحی را کاهش می دهد اما تأثیر قابل توجهی در حفظ سطح هموگلوبین و نیاز به تزریق خون پس از عمل جراحی ندارد.
واژگان کلیدی: آرتروپلاستی، تعویض مفصل زانو، تورنیکت، تزریق خون
کلیدواژه‌ها
عنوان مقاله [English]
A Comparative study of perioperative bleeding of total knee arthroplasty and the need for blood transfusion with and without use of tourniquet
نویسندگان [English]
- jafar Soleimanpoor
- Siamak Kazemi sufi
- Amin Moradi
Tabriz University of Medical Sciences
چکیده [English]
Background:
Total knee arthroplasty (TKA) is one of the most common orthopedic surgeries in the world. The use of tourniquet is recommended by some surgeons around the world. However, the evidence of its usefulness in replacing the knee is still uncertain. In the present study, we assessed the effect of using tourniquet in reducing bleeding during and after operation and the amount of transfusion requirement in TKA surgery.
Methods and Materials:
Patients referred to Imam Reza and Tabriz universal hospitals for TKA surgery in case of absence of hemorrhagic diseases and non-use of anticoagulants were included in this study. In this study, 8 (25.8%) males and 23 (74.2%) females were present with an average age of 63.6 ± 7.86 with a minimum age of 52 years and a maximum age of 81 years. Patients' Randomization applied considering balanced mean age and body mass index (BMI). In the first group after the patient's preparation and induction of anesthesia, the tourniquet was considered and surgery was performed and the tourniquet was released immediately after the cement was inserted. In the second group after the patient's preparation and induction of anesthesia, tourniquet was not used until cementation and after that again deflated. All surgical procedures were performed by the same and experienced surgical team using spinal epidural anesthesia. The standard surgical procedure was considered by surgeons.
Results:
23 (74.2%) patients did not need blood transfusion, and 8 (25.8%) patients needed transfusion. The average duration of surgery was 75.81 ± 26.3 minutes with a minimum duration of 30 minutes and a maximum of 125 minutes. The mean preoperative HB level was 12.66 ± 1.67, which was 11.09 ± 1.62 after surgery.
Conclusion:
In conclusion, the use of tourniquet in patients undergoing TKA surgery reduces the duration of surgery but does not significantly affect hemoglobin maintenance after surgery. In other words, the use of tourniquet does not have an effect on reducing the need for blood transfusion.
کلیدواژه‌ها [English]
- Total Knee Arthroplasty
- Tourniquet
- Hemoglobin
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