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Unexpected findings from an interdisciplinary case conference

机译：跨学科案例会议的意外发现

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Background and purpose Although a tourniquet may reduce bleeding during total knee replacement (TKA), and thereby possibly improve fixation, it might also cause complications. Migration as measured by radiostereometric analysis (RSA) can predict future loosening. We investigated whether the use of a tourniquet influences prosthesis fixation measured with RSA. This has not been investigated previously to our knowledge. Methods 50 patients with osteoarthritis of the knee were randomized to cemented TKA with or without tourniquet. RSA was performed postoperatively and at 6 months, 1 year, and 2 years. Pain during hospital stay was registered with a visual analog scale (VAS) and morphine consumption was measured. Overt bleeding and blood transfusions were registered, and total bleeding was estimated by the hemoglobin dilution method. Range of motion was measured up to 2 years. Results RSA maximal total point motion (MTPM) differed by 0.01 mm (95% CI 0.13 to 0.15). Patients in the tourniquet group had less overt bleeding (317 mL vs. 615 mL), but the total bleeding estimated by hemoglobin dilution at day 4 was only slightly less (1,184 mL vs. 1,236 mL) with a mean difference of 54 mL (95% CI 256 to 152). Pain VAS measurements were lower in the non-tourniquet group (p 0.01). There was no significant difference in morphine consumption. Range of motion was 11°more in the non-tourniquet group (p 0.001 at 2 years). Interpretation Tourniquet use did not improve fixation but it may cause more postoperative pain and less range of motion.
机译：背景和目的虽然止血带可能会在总膝关节替换期间减少出血（TKA），从而可能改善固定，也可能导致并发症。通过辐射静脉分析（RSA）测量的迁移可以预测未来的松动。我们调查了使用止血带的使用是否影响了RSA测量的假体固定。这尚未以前对我们的知识进行调查。方法50例膝关节的骨关节炎患者随机分配到有或没有止血带的粘液TKA。 RSA术后和6个月，1年和2年进行。住院期间疼痛在视觉模拟规模（VAS）中注册，并测量了吗啡消耗。注册了明显的出血和输血，通过血红蛋白稀释法估算了全渗流。测量运动范围长达2年。结果RSA最大总点运动（MTPM）不同0.01毫米（95％CI 0.13至0.15）。止血带组中的患者具有较少的出血（317ml与615mL），但是在第4天血红蛋白稀释估计的总出血仅略低于（1,184ml与1,236ml），平均差异为54mL（95个％CI 256至152）。非止血带组疼痛VAS测量较低（P 0.01）。吗啡消费没有显着差异。非止血带组的运动范围为11°（2岁的P <0.001）。解释止血带使用没有改善固定，但它可能导致更术后的痛苦和更少的运动范围。

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  • 来源
    《Medical teacher》 |2012年第10期|共2页
  • 作者

    OudeRengerinkK.; BeckG.L.; KhanK.; HaniganM.J.; HorvathA.R.; MeyerroseB.; WalczakJ.; SuterK.; MolB.W.;

  • 作者单位

    Department of Obstetrics and Gynaecology Academic Medical Center University of Amsterdam 1105 AZ;

    Department of Pediatrics University of Nebraska College of Medicine Omaha NE United States;

    Department of Obstetrics and Gynaecology Academic Medical Center University of Amsterdam 1105 AZ;

    Meridian Mental Health Associates Omaha NE United States;

    Department of Obstetrics and Gynaecology Academic Medical Center University of Amsterdam 1105 AZ;

    Department of Obstetrics and Gynaecology Academic Medical Center University of Amsterdam 1105 AZ;

    Department of Obstetrics and Gynaecology Academic Medical Center University of Amsterdam 1105 AZ;

    Department of Obstetrics and Gynaecology Academic Medical Center University of Amsterdam 1105 AZ;

    Department of Obstetrics and Gynaecology Academic Medical Center University of Amsterdam 1105 AZ;

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  • 正文语种 eng
  • 中图分类 医药、卫生;
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