Kerem BAŞARIR, Mahmut KALEM, Hakan KOCAOĞLU, Bülent ERDEMLİ, Anıl Özbek

Total Diz Artroplastisinde Cerrahi Süresince Pnömatik Turnike Kullanımı ile Çimentolama Sırasında Pnömatik Turnike Kullanılmasının Erken Dönem Kan Kaybı Üzerinde Etkisi

Amaç: Total diz protezi (TDP) cerrahisi sırasında turnike kullanımı intraoperatif kan kaybını ve cerrahi saha görünümünü artırmak için kullanılmaktadır.Ancak güncel literatürde turnike kullanım teknikleri ile değişik sonuçlar bulunmaktadır. Retrospektif olarak planladığımız çalışmamızın amacı; TDPcerrahisi süresi boyunca turnike kullanılmış hastalar ile, yalnızca çimentolama esnasında turnike kullanılmış hastaların postoperatif kan kaybı ve kantransfüzyon ihtiyaçlarını belirleyerek intraoperatif turnike kullanım süresinin postoperatif kan kaybına etkisini irdelemektir.Gereç ve Yöntem: Çalışmamıza 407 hasta dahil edilmiş olup 153 hastanın (grup 1) tüm TDP cerrahisi süresinde turnike kullanılmış, 254 hastanın isecerrahi içerisinde sadece çimentolama aşamasında turnike kullanılmıştır. Hastaların preoperatif ve postoperatif hemoglobin (Hb), hemotokrit (Htc),trombosit (Plt), beyaz küre ve postoperatif kan transfüzyon ihtiyaçları karşılaştırılmıştır.Bulgular: Çalışmamız sonucunda her iki grup içinde postoperatif Hb, Htc, Plt değerleri açısından anlamlı düşüş saptanır (p0,05). Benzer şekilde, iki grup arasında postoperatif kan transfüzyon ihtiyacı açısından daistatistiksel anlamlı fark saptanmamıştır.Sonuç: Çalışmamız sonucunda elde ettiğimiz veriler ışığında; intraoperatif kullanılan transamin ve diğer kanama azaltıcı yöntemler ile beraber sadeceçimentolama sırasında kullanılan turnike uygulaması postoperatif kan kaybı ve kan transfüzyon ihtiyacı için, tüm cerrahi süresince kullanılan turnikeyöntemi kadar etkili bir yöntemdir. Buna ek olarak turnike bağlı gelişen postoperatif komplikasyonları azaltıcı bir yöntem olduğu düşünülmektedir.

Effect of Tourniquet Inflated for All the Surgery Versus Tourniquet Inflated Only at the Time of Cementation on Early Blood Loss at Total Knee Arthroplasty

Objectives: Tourniquet is used at total knee arthroplasty (TKA) for decreasing intra-operative blood loss and to provide a blood free exposure. However, there are many discrepancies for the ideal tourniquet technique. Our study aims to compare two tourniquet using techniques, throughout the surgery vs. only at the time of cementing components, by means of early blood loss retrospectively at TKA . Materials and Methods: Four hundred and seven patients were enrolled to our study where 153 of them were operated with tourniquet inflated for all the TKA surgery while 254 of them operated with the tourniquet inflated only at the time of cementation. Hemoglobin (Hb), hematocrit (Htc), platelet (Plt), white blood cell counts for pre-operative and postoperative period and early postoperative need for blood transfusion data were extracted. Results: Results revealed that for both groups Hb, Htc and Plt levels drop postoperatively while the there was no difference in-between groups. Also, the need for blood transfusion was not significantly different. Conclusion: Our results confirm with the help of supplementary measures like tranexamic acid and hypotensive anesthesia tourniquet use for only cementing the components is effective as prolonged usage of tourniquet by means of early blood loss at TKA. We also believe this kind of tourniquet regimen will reduce complications.

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