Total diz protezi uygulamalarında turnike kullanımının etkileri

Amaç: Total diz protezi uygulamalarında turnike kullanımının kanama miktarı ve rehabilitasyon üzerine etkileri incelendi. Çalışma planı: Osteoartrit tanısıyla tek taraflı total diz protezi (TDP) uygulaması planlanan 32 hasta turnike kullanılan ve kullanılmayanlar olarak iki eşit gruba ayrılarak prospektif olarak değerlendirildi. Tüm olgularda çimentolu ve çapraz bağı korumayan tipte total diz protezi uygulandı. Ameliyat sırasında ölçülen ve hemovak drende toplanan kan miktarı toplamı, toplam kan kaybı olarak değerlendirildi. Ameliyat sonrası birinci günde rehabilitasyona (düz bacak kaldırma testi ve mobilizasyon) başlayabilen olgular ve dizin 90° fleksiyonuna erişme süresi kaydedildi. Sonuçlar: Turnike uygulanan grup I’de kan kaybı ortalama 1048.7 ml, turnike uygulanmayan grup II’de 893.7 ml bulundu.

Anahtar Kelimeler:

Fibrinoliz, Diz protezi, Ameliyat sonrası komplikasyonlar, Artroplasti, replasman, diz, Turnikeler, Hemostaz, cerrahi

The effect of tourniquet use in total knee prosthesis

Objectives: The effects of tourniquet use were evaluated with regard to blood loss and rehabilitation in patients undergoing total knee prosthesis (TKP). Methods: Thirty-two consecutive patients with osteoarthritis were prospectively divided into two equal groups for TKP with or without tourniquet. Cemented and posteriorly stabilized total knee prosthesis was used in all patients. The amount of blood obtained in the Hemovac drain was assessed as total blood loss. Patients in whom rehabilitation was initiated on the first postoperative day (straight leg raising and mobilization) and the duration for the knee to reach a flexion of 90 degrees were recorded. Results: The mean amount of blood loss was 1048.7 ml in group I with tourniquet compared with 893.7 ml in group II without tourniquet (p<0.05). The mean durations for the initiation of straight leg raising exercises and mobilization, when adequate analgesia was provided, were 1.93 and 1.25 days in groups I and II, respectively (p<0.05). No significant differences were found in terms of operation time, length of hospitalization, duration for the knee to reach a 90° flexion, and the need for transfusion (p>0.05). Preoperative hemoglobin values of patients with or without transfusion differed significantly (p<0.05). Conclusion: Total knee prosthesis without the use of a tourniquet seems to be more reliable and convenient than that with tourniquet due to less total blood loss, and tourniquet-associated adverse effects such as delayed rehabilitation and increased postoperative morbidity and complications.

Keywords:

Fibrinolysis, Knee Prosthesis, Postoperative Complications, Arthroplasty, Replacement, Knee, Tourniquets, Hemostasis, Surgical,

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