【作者】 黄星；

【导师】 姚军；

【作者基本信息】 广西医科大学 ， 外科学（专业学位）， 2022， 硕士

【摘要】 研究目的:在膝关节镜下前交叉韧带重建术(ACLR)中减少止血带的使用时间,ACLR是否能顺利的进行,是否能减少ACLR术后并发症的发生,以及是否能促进ACLR术后的早期快速康复。方法:选取2021年8月至2022年4月于广西医科大学第一附属医院骨关节外科行取自体半腱肌及股薄肌,经膝关节镜下单束重建膝关节前交叉韧带术(ACLR)的患者80例,男51例,女29例,年龄分布17～57岁,随机分为两组,实验组(n=40)和对照组(n=40)。A组,ACLR术中全程使用每袋加入有1mg盐酸肾上腺素的等渗冲洗液进行膝关节腔冲洗,在取肌腱必要时予止血带辅助止血。B组手术全程使用气囊型止血带止血,压力50Kpa。收集两组患者的一般资料(姓名、性别、年龄、身高、体重、住院号、BMI、受伤部位等);记录手术时间、使用止血带的时间、半月板修复情况以及术前和术后的KT1000值,并计算出差值;记录术中手术视野的清晰度(优秀、良好、差);记录术前、术后24h、48h的静息和活动下的疼痛视觉模拟评分(VAS评分),0～10分,所得分值越高代表疼痛越剧烈;记录术前、术后24h、48h的股四头肌的肌力,0-5级,数值越高表示肌力越好;记录术前、术后24h、48h的患侧髌上囊2cm的肢体周径,并计算出与术前比较的差值;记录术前、术后24h、48h的患侧膝关节的积血积液量;记录术后患者出现恶心、呕吐、头晕、头痛、皮疹、下肢深静脉血栓形成等不良反应。结果:两组80例患者全部按计划进行术后随访。在两组一般资料的比较,在性别、年龄、BMI、受伤部位、手术时间、术中修复半月板情况、术前和术后KT1000的差值均未见显著差异(P>0.05);两组患者ACLR术中的手术视野清晰度(优秀、良好、差)的比较:A组和B组未见明显差异(P>0.05);两组患者ACLR术中使用止血带的时间的比较:A组显著低于B组,差异具有统计学意义(P<0.05);两组患者住院时间的比较:A组住院时间显著低于B组,具有明显差异(P<0.05);两组患者术前、术后静息和动态状态下VAS评分的比较:术后24h、48h静息和动态下,A组显著低于B组,具有明显差异(P<0.05)。术前静息和动态下两组比较未见明显差异(P>0.05);两组患者术后24h、48h膝关节积血积液量的比较:A组显著少于B组,具有明显差异(P<0.05);两组患者术后24h、48h的髌上囊2cm的肢体周径差值的比较:A组显著低于B组,具有明显差异(P<0.05);两组患者术后24h、48h股四头肌肌力的比较:A组显著高于B组,具有明显差异(P<0.05),但两组股四头肌肌力在术前的比较未见显著差异(P>0.05)。结论:减少止血带在ACLR中的使用时间,ACLR依然能顺利的进行,手术视野和手术时间与对照组相比没有明显差异;可以减轻ACLR术后的膝关节肿胀、膝关节积血积液量以及患侧肢体的疼痛;可以促进患者本体感觉和股四头肌肌力的恢复,减少患者平均住院时间,加速患者术后的早期快速康复进程,以较小的成本提供了一种简单、安全、有效的方法,有利于患者术后早期快速康复,增加患者满意度,为临床提供参考。更多还原

【Abstract】 Purpose Reducing the use time of tourniquet in arthroscopic anterior cruciate ligament reconstruction(ACLR),whether ACLR can be carried out smoothly,whether the occurrence of postoperative complications of ACLR can be reduced,and whether the early postoperative recovery of ACLR can be promoted.Methods A total of 80 patients(51 males and 29 females,aged 17 to 57 years old)who underwent arthroscopic single-band anterior cruciate ligament reconstruction(ACLR)from semitendinosus and gracilis muscle were randomly divided into two groups from August 2021 to April 2022 in the Department of Osteoarthroplasty of the First Affiliated Hospital of Guangxi Medical University.Experimental group(n=40)and control group(n=40).In group A,ACLR was irrigated with isotonic rinse solution containing 1mg epinephrine hydrochloride for the knee cavity throughout the operation,and A short-term tourniquet was used to assist hemostasis when tendon extraction was necessary.In group B,balloon tourniquet was used for hemostasis throughout the operation,with a pressure of 50 Kpa.General information(name,sex,age,height,weight,hospital number,BMI,injury site,etc.)of patients in the two groups were collected.Operation time,tourniquet duration,meniscus repair,preoperative and postoperative KT1000 values were recorded and travel values were calculated.The visual analogue scale(VAS)of pain at rest and under activity were recorded before,24 h and 48 h after surgery,with 0～10 points,and the higher the score,the more severe the pain.The muscle strength of the quadriceps femoris was recorded before,24 h and 48 h after the operation,and was graded0-5.The higher the value,the better the muscle strength.The limb circumference of 2cm of the suprapatellar bursa of the affected side was recorded before,24 h and 48 h after surgery,and the difference between the two was calculated.The amount of blood and fluid in the affected knee joint was recorded before,24 and48 hours after operation.Postoperative adverse reactions such as nausea,vomiting,dizziness,headache,rash and deep venous thrombosis of lower limbs were recorded.Result All 80 patients in both groups were followed up as planned.Comparison of general data between the two groups showed no significant differences in gender,age,BMI,injury site,operation time,meniscus repair during operation,and preoperative and postoperative KT1000 differences(P>0.05).Comparison of intraoperative operative visual ACLR clarity(excellent,good,poor)between the two groups: no significant difference was observed between group A and group B(P > 0.05).Comparison of the duration of intraoperative tourniquet use in ACLR between the two groups: Group A was significantly lower than group B,with statistically significant difference(P<0.05).Comparison of hospitalization time between the two groups:hospitalization time in group A was significantly lower than that in group B,with significant difference(P<0.05).Comparison of VAS scores between the two groups at resting and dynamic state before and after surgery: at resting and dynamic state 24 h and 48 h after surgery,group A was significantly lower than group B,showing significant differences(P<0.05).There was no significant difference between the two groups in preoperative resting and dynamic conditions(P>0.05).Comparison of the amount of blood and fluid in knee joint between the two groups at 24 h and 48 h after surgery: Group A was significantly less than group B,with significant difference(P<0.05).Comparison of 2cm limb circumference diameter difference between the two groups 24 h and 48 h after surgery: group A was significantly lower than group B,with significant difference(P < 0.05).Comparison of muscle strength of quadriceps femoris between the two groups at 24 h and 48 h after surgery: group A was significantly higher than group B,with significant difference(P < 0.05),but there was no significant difference in muscle strength of quadriceps femoris between the two groups before surgery(P > 0.05)。Conclusion The use time of tourniquet in ACLR was reduced,and ACLR was still carried out smoothly.There was no significant difference in surgical field and operation time between the control group and the control group.It can reduce the swelling of knee joint,the amount of blood and fluid in knee joint and the pain of affected limbs after ACLR.Can promote the quadriceps muscle and patients feeling of ontology and the recovery of muscle strength,reduce the patients’ average hospitalization time,accelerate the postoperative patients with early rehabilitation process rapidly and with less cost provides a simple,safe and effective method,is helpful for early postoperative patients with rapid recovery,increase patient satisfaction,provide reference for clinical.更多还原