止血带的使用有助于减少骨关节炎患者接受全膝关节置换术的术中失血:一项具有试验序列分析的最新荟萃分析。

IF 1.3 4区 医学 Q3 ORTHOPEDICS Journal of Orthopaedic Surgery Pub Date : 2023-05-01 DOI:10.1177/10225536231191607
Xiangjun Xu, Chao Wang, Qunshan Song, Zhifang Mou, Yuefu Dong
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引用次数: 0

摘要

目的:在骨关节炎患者的全膝关节置换术(TKA)中使用止血带的有效性和安全性仍存在争议。这项最新的系统综述和荟萃分析旨在通过引入试验序列分析,进一步评估止血带在膝骨关节炎TKA患者中的作用。方法:检索PubMed、Embase和Cochrane图书馆。我们使用Cochrane偏倚风险工具进行质量评估。使用Cochran的Q和I2统计量评估研究之间的统计学异质性。使用Stata/SE 14.0进行荟萃分析,使用TSA软件0.9.5.10 Beta版进行追踪序列分析。此外,定性总结也用于描述结果。结果:荟萃分析包括15项随机对照试验(RCT),涉及1202名患者。汇总结果显示,TKA期间使用止血带显著减少了术中失血量(平均值差异(MD)=-123.84,95%置信区间(CI):-163.37至-84.32,p<.001)和缩短了手术时间(MD=-4.71,95%CI:-7.6至-1.82,p=.001),但术后失血量、计算失血量、总失血量,止血带组和无止血带的组之间的血栓形成率、输血率(p=.939)和深静脉血栓形成率(DVT)。TSA证实手术时间的结果是假阳性,但其他结果的结果是决定性的。定性总结的结果显示,两组在疼痛、活动范围(RoM)和肿胀率方面存在矛盾。结论:在接受TKA治疗骨关节炎的患者中使用止血带有助于减少术中失血,但对术后失血、计算失血、总失血、手术时间、输血率和DVT率没有影响。此外,止血带和非止血带组在疼痛、RoM和肿胀率方面的差异尚不清楚。
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Tourniquet use benefits to reduce intraoperative blood loss in patients receiving total knee arthroplasty for osteoarthritis: An updated meta-analysis with trial sequential analysis.

Purpose: The efficacy and safety of tourniquets use during total knee arthroplasty (TKA) in patients with osteoarthritis remain debated. This updated systematic review and meta-analysis aimed to further evaluate the role of tourniquets use in patients undergoing TKA for knee osteoarthritis by introducing trial sequential analysis.

Methods: PubMed, Embase, and the Cochrane Library were searched. We used the Cochrane risk of bias tool for quality assessment. Statistical heterogeneity across studies was evaluated using Cochran's Q and I2 statistic. Meta-analysis was performed using Stata/SE 14.0, and trail sequential analysis was performed using TSA software version 0.9.5.10 Beta. In addition, qualitative summary was also used to describe results.

Results: 15 randomized controlled trials (RCTs) involving 1202 patients were included in the meta-analysis. The pooled results showed that tourniquet use during TKA significantly reduced intraoperative blood loss (mean difference (MD)= -123.84, 95% confidence interval (CI): -163.37 to -84.32, p < .001)and shortened operation time (MD = -4.71, 95% CI: -7.6 to -1.82, p = .001), but there were no significant differences in postoperative blood loss, calculated blood loss, total blood loss, transfusion rate (p = .939), and deep venous thrombosis (DVT) rate between the tourniquet and no-tourniquet groups. TSA confirmed that the result of operation time was false positive, but the results of other outcomes were conclusive. The results of qualitative summary showed conflicting findings in terms of pain, range of motion (RoM) and swelling ratio between the two groups.

Conclusions: Tourniquet use in patients receiving TKA for osteoarthritis benefits to reduce intraoperative blood loss but has no effect on postoperative blood loss, calculated blood loss, total blood loss, operation time, transfusion rate, and DVT rate. In addition, it remains unclear the difference between the tourniquet and non-tourniquet groups in terms of pain, RoM and swelling ratio.

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来源期刊
Journal of Orthopaedic Surgery
Journal of Orthopaedic Surgery ORTHOPEDICS-SURGERY
CiteScore
3.10
自引率
0.00%
发文量
91
审稿时长
13 weeks
期刊介绍: Journal of Orthopaedic Surgery is an open access peer-reviewed journal publishing original reviews and research articles on all aspects of orthopaedic surgery. It is the official journal of the Asia Pacific Orthopaedic Association. The journal welcomes and will publish materials of a diverse nature, from basic science research to clinical trials and surgical techniques. The journal encourages contributions from all parts of the world, but special emphasis is given to research of particular relevance to the Asia Pacific region.
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