Objective To investigate the effect of non-whole-time application of tourniquet in arthroscopy combined with high tibial osteotomy on clinical outcomes. Methods Clinical data of patients who underwent arthroscopic combined tibial high osteotomy in our hospital from June 2018 to January 2022 were retrospectively analyzed, and a total of 72 patients were included in this study according to the inclusion and exclusion criteria, which were divided into 38 cases in the whole time tourniquet application group and 34 cases in the tourniquet application group only in the arthroscopic exploration stage, and the perioperative indicators were recorded and compared between the two groups. Results （1）There was no statistical difference in terms of operative time and hospitalization days (P>0.05). （2）There was no statistical difference in terms of postoperative hemoglobin, hematokrit, drainage volume, blood loss and transfusion rate between the two groups (P>0.05). （3）The non-whole-time tourniquet group had lower pain scores in the early postoperative period and could achieve better range of motion on the third postoperative day (P<0.05). （4）There was less incidence of thigh pain in the non-whole-time tourniquet group (P<0.05), but there was no statistical difference in other complications between the two groups (P>0.05). Conclusions The results suggest that the use of tourniquet only in the stage of arthroscopic exploration will not increase the postoperative blood loss, operation time and hospital stay after high tibial osteotomy. However, it can reduce the pain of knee and tourniquet site in the early postoperative period, which is conducive to the early postoperative functional recovery, and will not increase the incidence of complications.
Key words
Knee; /
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Osteoarthritis; /
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High tibial osteotomy; /
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Arthroscopy; /
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Tourniquet; /
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Perioperative period
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References
[1] 刘洋, 梁涛, 张磊, 等. 3D打印辅助胫骨高位开放截骨联合关节镜治疗膝内翻畸形临床疗效分析[J]. 中国临床解剖学杂志, 2020, 38(1): 67-72. DOI: 10.13418/j.issn.1001-165x.2020.01.014.
[2] Katagiri H, Nakagawa Y, Miyatake K, et al. Short-term outcomes after high tibial osteotomy aimed at neutral alignment combined with arthroscopic centralization of medial meniscus in osteoarthritis patients[J]. J Knee Surg, 2023, 36(3):261-268. DOI: 10.1055/s-0041-17317 38. Epub 2021 Jul 14.
[3] Dennis DA, Kittelson AJ, Yang CC, et al. Does tourniquet use in TKA affect recovery of lower extremity strength and function? a randomized trial[J]. Clin Orthop Relat Res, 2016, 474(1): 69-77. DOI: 10.1007/s11999-015-4393-8.
[4] Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults[J]. Surgery, 1962, 51(2): 224-232. PMID: 21936146.
[5] Yi S, Tan J, Chen C, et al. The use of pneumatic tourniquet in total knee arthroplasty: a meta-analysis[J]. Arch Orthop Trauma Surg, 2014, 134(10): 1469-1476. DOI: 10.1007/s00402-014-2056-y.
[6] 陈森荣, 肖军, 李强, 等. 氨甲环酸联合不同抗凝药对全膝关节置换术围手术期失血量的影响[J]. 中国临床解剖学杂志, 2022, 40(3): 356-361. DOI: 10.13418/j.issn.1001-165x.2022.3.20.
[7] Li S, Zhang X, Liu M, et al. Not using a tourniquet is superior to tourniquet use for high tibial osteotomy: a prospective, randomised controlled trial[J]. Int Orthop, 2022, 46(4): 823-829. DOI: 10.1007/s00264-021-05246-4.
[8] Wang L, Zhang Z, Xiong W, et al. Impact of tourniquet on short-term outcomes in opening wedge high tibial osteotomy with modern tranexamic acid protocols: a retrospective cohort study[J]. BMC Musculoskelet Disord, 2021, 22(1): 931. DOI: 10.1186/s12891-021-04830-4.
[9] Guler O, Mahirogullari M, Isyar M, et al. Comparison of quadriceps muscle volume after unilateral total knee arthroplasty with and without tourniquet use[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(8): 2595-2605. DOI: 10.1007/s00167-015-3872-5.
[10]Hakkalamani S, Clark V, Pradhan N. Short versus standard duration tourniquet use during total knee replacement: a pilot study[J]. Acta Orthop Belg, 2015, 81(1): 52-56. PMID: 26280855.
[11]El-Galaly A, Hansen AT, Kappel A. The use of tourniquet in primary total knee arthroplasty does not increase the risk of venous thromboembolism within 90 days of surgery: a Danish nationwide cohort study of 19,804 patients[J]. Knee Surg Sports Traumatol Arthrosc, 2023, 31(3): 883-891. DOI: 10.1007/s00167-022-06965-w.
[12]Huang CR, Pan S, Li Z, et al. Tourniquet use in primary total knee arthroplasty is associated with a hypercoagulable status: a prospective thromboelastography trial[J]. Int Orthop, 2021, 45(12): 3091-3100. DOI: 10.1007/s00264-021-05126-x.
[13]Liu PL, Li DQ, Zhang YK, et al. Effects of unilateral tourniquet used in patients undergoing simultaneous bilateral total knee arthroplasty[J]. Orthop Surg, 2017, 9(2): 180-185. DOI: 10.1111/os.12329.
[14]Martin R, Birmingham TB, Willits K, et al. Adverse event rates and classifications in medial opening wedge high tibial osteotomy[J]. Am J Sports Med, 2014, 42(5): 1118-1126. DOI: 10.1177/03635465145 25929.
[15]Hernandez AJ, Almeida AM, Favaro E, et al. The influence of tourniquet use and operative time on the incidence of deep vein thrombosis in total knee arthroplasty[J]. Clinics (Sao Paulo), 2012, 67(9): 1053-1057. DOI: 10.6061/clinics/2012(09)12.
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