Kai Hoffeld, Christopher Wahlers, Jan P Hockmann, Michael Sarter, Lars P Müller, Michael Hackl, Tim Leschinger
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引用次数: 0
Abstract
Background: Pneumatic tourniquets are frequently employed in extremity surgeries, aiming to enhance intraoperative visibility and minimize blood loss. While their benefits and drawbacks have been extensively studied in lower limb operations, their impact on upper limb procedures, particularly elbow surgery, remains poorly understood. This study investigates the advantages and risks associated with pneumatic tourniquet utilization in elbow surgery.
Methods: A retrospective analysis was conducted on 183 patients who underwent elbow surgery for fractures between January 2019 and September 2023. Patients were categorized into two groups: those who underwent surgery with a tourniquet (WT) and those without a tourniquet (NT). Subgroup analyses were performed based on fracture complexity. Data collected included patient characteristics, tourniquet usage, surgical duration, pre- and postoperative hemoglobin levels, C-reactive protein levels, pain assessments, opioid administration, hospital stay duration, follow-up, complications, and revisions. Statistical analyses were used to identify significant differences and correlations.
Results: The use of a tourniquet in elbow surgery yielded several notable outcomes. Patients in the WT group experienced significantly shorter surgical durations and hospital stays. Hemoglobin drop was lower in the WT group, indicating reduced blood loss. However, there were no significant differences in postoperative pain, opioid consumption, or complications between the WT and NT groups. Subgroup analysis revealed that the recorded differences, particularly shorter surgical durations, were more pronounced in complex fractures.
Conclusions: This study shows promising results in the use of pneumatic tourniquets in elbow surgery in terms of enhanced efficiency, reduced blood loss, and overall safety, without compromising patient outcomes. However, the potential influence of perioperative decision-making on tourniquet usage underscores the need for further research to elucidate its role and optimize its application, especially in complex elbow fractures.
背景：四肢手术中经常使用气动止血带，目的是提高术中可视性并尽量减少失血。虽然对气动止血带在下肢手术中的优点和缺点进行了广泛研究，但对其对上肢手术，尤其是肘部手术的影响仍知之甚少。本研究调查了在肘部手术中使用气动止血带的优点和相关风险：对2019年1月至2023年9月期间因骨折接受肘部手术的183名患者进行了回顾性分析。患者分为两组：使用止血带（WT）和不使用止血带（NT）的患者。根据骨折复杂程度进行分组分析。收集的数据包括患者特征、止血带使用情况、手术时间、术前和术后血红蛋白水平、C反应蛋白水平、疼痛评估、阿片类药物用量、住院时间、随访、并发症和翻修。统计分析用于确定显著差异和相关性：结果：在肘关节手术中使用止血带产生了几个显著的结果。WT组患者的手术时间和住院时间明显缩短。WT 组血红蛋白下降较低，表明失血量减少。不过，WT 组和 NT 组在术后疼痛、阿片类药物用量或并发症方面没有明显差异。分组分析显示，所记录的差异，尤其是较短的手术时间，在复杂骨折中更为明显：这项研究表明，在肘部手术中使用气动止血带在提高效率、减少失血量和整体安全性方面都有良好的效果，而且不会影响患者的预后。然而，围手术期决策对止血带使用的潜在影响凸显了进一步研究的必要性，以阐明止血带的作用并优化其应用，尤其是在复杂的肘部骨折中。
期刊介绍：
The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.
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