Procedures under tourniquet in sickle cell disease: safety evaluated in two hundred and thirty three sickle-cell disease anaemia adult patients in comparison with outcomes in five hundred and seventy four sickle cell anaemia patients with procedures without tourniquet.
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Abstract
Purpose: There is a lack of data evaluating the impact of tourniquet versus no tourniquet surgery in patients with sickle cell disease (SCD).
Methods: The records of 233 sickle cell patients who underwent orthopaedic surgery with a tourniquet between 1978 and 2018 were retrospectively reviewed. This study group (233 patients) was compared to a control group of 574 SCD patients followed by the same surgical team in the same hospital undergoing the same procedures in the same period between 1978 and 2018 but without a tourniquet. Outcomes assessed skin complications, thrombophlebitis, bone necrosis, muscle necrosis or abnormal muscle function, peripheral nerve impairment, elevated blood pressure, post-operative sickle cell crises, and blood loss under a tourniquet.
Results: The pneumatic tourniquet was primarily applied proximally in both lower and upper limbs. The median tourniquet duration was 65 minutes, with most procedures lasting between 30 and 90 minutes . Postoperative medical complications occurred in both groups, with no significant difference in hospital stay (6.7 vs. 7.1 days). Painful sickling crises affected 86 patients, with a lower prevalence in transfused patients (p = 0.04). Blood loss was significantly lower in the tourniquet group during knee surgeries (438 ml vs. 731 ml, p = 0.031), resulting in fewer transfusions. Skin complications did not affect wound healing. The 90-day incidence of venous thromboembolism (VTE) was 0.4%, with no significant difference between groups. Muscle biopsies showed no necrosis immediately post-surgery, but some necrosis appeared after 12 weeks in the tourniquet group. New bone osteonecrosis cases and infection rates were similar between groups.
Conclusion: this study provides valuable insights into the use of tourniquets in sickle cell disease.
目的：目前缺乏评估止血带与无止血带手术对镰状细胞病（SCD）患者影响的数据。方法：回顾性分析1978年至2018年233例接受止血带骨科手术的镰状细胞病患者的临床资料。该研究组（233名患者）与对照组（574名SCD患者）进行了比较，对照组由同一家医院的同一外科团队在1978年至2018年的同一时期进行了相同的手术，但没有使用止血带。结果评估皮肤并发症、血栓性静脉炎、骨坏死、肌肉坏死或肌肉功能异常、周围神经损伤、血压升高、术后镰状细胞危像和止血带下失血。结果：气动止血带主要应用于下肢和上肢近端。止血带的中位数持续时间为65分钟，大多数手术持续时间为30至90分钟。两组术后均出现并发症，住院时间差异无统计学意义（6.7天vs 7.1天）。86例患者出现了疼痛性镰状危像，输血患者的患病率较低（p = 0.04）。止血带组膝关节手术期间出血量明显降低（438 ml vs 731 ml, p = 0.031），输血量减少。皮肤并发症不影响伤口愈合。90天静脉血栓栓塞（VTE）发生率为0.4%，组间差异无统计学意义。术后肌肉活检未见坏死，止血带组术后12周出现部分坏死。两组间新发骨坏死病例及感染率相似。结论：本研究为止血带在镰状细胞病中的应用提供了有价值的见解。
期刊介绍：
International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters.
Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
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The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.
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