在前交叉韧带重建中使用止血带与术后股四头肌萎缩和疼痛有关，但从长期来看没有负面影响：一项系统综述

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-04-01 DOI:10.1016/j.asmr.2024.101040

Caleb V. Hayes B.S. , Saad M. Ibrahim B.S. , Anna E. Crawford B.S. , James R. Jones M.D. , Mathew D. Hargreaves B.S. , Clay A. Rahaman B.A. , Eugene W. Brabston M.D. , Thomas B. Evely M.D. , Aaron J. Casp M.D. , Kevin E. Wilk D.P.T. , Amit M. Momaya M.D.

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Randomized controlled trials and nonrandomized studies that evaluated intraoperative and postoperative effects of tourniquet usage during arthroscopic ACL reconstruction published between November 1996 and January 2023 were included. Outcomes evaluated included intraoperative visualization, pain, quadricep strength thigh or calf girth, blood loss, and operative time.</div></div><div><h3>Results</h3><div>Eight studies with 502 total patients were included in this review. There were 253 total patients in the tourniquet (T) group and 249 in the non-tourniquet (NT) group. Postoperative blood loss was higher in the T group (<em>P</em> < .05). Two studies reported significantly increased postoperative analgesic usage within the T group (<em>P</em> < .05), while 2 studies listed no significant differences between groups. 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引用次数: 0

摘要

目的探讨前交叉韧带重建术中止血带的使用对股四头肌力量、术中术后出血量、手术时间、大腿围或小腿围及术后疼痛的影响。方法采用PubMed、EMBASE和Cochrane系统评价数据库，按照PRISMA指南进行系统评价。纳入1996年11月至2023年1月发表的评估关节镜下ACL重建术中和术后使用止血带效果的随机对照试验和非随机研究。评估的结果包括术中视觉、疼痛、股四头肌力量、大腿或小腿围、出血量和手术时间。结果8项研究共纳入502例患者。止血带(T)组253例，非止血带（NT）组249例。T组术后出血量较高(P <；. 05)。两项研究报告了T组术后镇痛药的使用显著增加(P <；0.05)， 2项研究未发现组间差异显著。两组术后2 d疼痛均未明显增加；然而，有2项研究报告T组在术后10小时内疼痛增加（P < 0.05）。虽然有3项研究表明手术后T组的股四头肌力量最初有所下降(P <；.05)，总体结果一致表明股四头肌力量在几周内恢复。同样，在大腿或小腿围方面也没有长期的显著差异。在纳入的研究中，使用止血带可减少手术时间，其中1项研究显示有显著差异(P <；. 05)。结论在前交叉韧带重建中使用止血带对股四头肌力量无长期负面影响。虽然止血带的使用与术后四头肌萎缩和疼痛的增加有关，但这些影响并没有持续下去。证据水平：II级，对I级和II级研究的系统评价。

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Tourniquet Use During Anterior Cruciate Ligament Reconstruction Is Associated With Postoperative Quadriceps Atrophy and Pain but No Negative Effects in the Long Term: A Systematic Review

Purpose

To evaluate the effect of tourniquet use during ACL reconstruction on quadriceps strength, intraoperative and postoperative blood loss, operative time, thigh girth or calf girth, and postoperative pain.

Methods

A systematic review using PubMed, EMBASE, and Cochrane Database of Systematic Reviews was conducted following the PRISMA guidelines. Randomized controlled trials and nonrandomized studies that evaluated intraoperative and postoperative effects of tourniquet usage during arthroscopic ACL reconstruction published between November 1996 and January 2023 were included. Outcomes evaluated included intraoperative visualization, pain, quadricep strength thigh or calf girth, blood loss, and operative time.

Results

Eight studies with 502 total patients were included in this review. There were 253 total patients in the tourniquet (T) group and 249 in the non-tourniquet (NT) group. Postoperative blood loss was higher in the T group (P < .05). Two studies reported significantly increased postoperative analgesic usage within the T group (P < .05), while 2 studies listed no significant differences between groups. Postoperative pain was not significantly increased in either group 2 days postoperation; however, 2 studies reported an increase in pain in the T group within the 10-hour, postoperative window (P <.05). Although 3 studies indicated an initial decrease in quadriceps strength within the T group following surgery (P < .05), overall findings consistently demonstrated a recovery of quadriceps strength within a few weeks. Similarly, there were no long-term significant differences in thigh or calf girth reported. Decreased operative time was reported with tourniquet use across included studies with 1 study demonstrating a significant difference (P < .05).

Conclusions

Tourniquet use during ACL reconstruction does not have negative long-term effects on quadriceps strength. Although tourniquet use was associated with increased quadriceps atrophy and pain in the immediate postoperative period, these effects did not persist.