一項發表於J Bone Joint Surg Am雜誌的回顧性研究顯示，全膝置換術中有限的使用止血帶反而會導致失血量的增加。作者建議醫生們應該考慮在全膝置換術中不要常規使用止血帶。
全膝關節置換術中使用止血帶是為了減少圍手術期失血，但卻存在安全性和效果的問題；而氨甲環酸則可以通過穩定凝血塊的形成起到降低失血量作用的。鑑於以上原因，很多資深醫生已經不再在全膝置換術中常規使用止血帶了，而是常規使用氨甲環酸來止血了。因此本研究目的是對比術中使用止血帶、使用止血帶加氨甲環酸和單獨使用氨甲環酸的圍手術期失血情況。
作者回顧性的研究了132名患者，將他們分成3組。第一組採用全膝置換術中有限使用止血帶（上骨水泥時使用），第二組是有限使用止血帶結合氨甲環酸，第三組是隻使用氨甲環酸而不用止血帶。採用Gross公式計算圍手術期失血量。
結果顯示，單獨使用止血帶的第一組的失血量是最高的，為平均1591.39ml（95%可信區間[CI], 1,064.97 到 2,117.81 mL）。止血帶結合氨甲環酸的第二組的失血量要低一些，為1215.34ml（95% CI, 1,104.93 到 1,325.75 mL）。單獨使用氨甲環酸的第三組的失血量最低，為1007.22ml（95% CI, 878.78到1,135.66 mL）。
原文摘要：
Use of a Tourniquet in Total Knee Arthroplasty Causes a Paradoxical Increase in Total Blood Loss
BACKGROUND: A tourniquet in total knee arthroplasty has been used in an attempt to decrease perioperative blood loss; however, questions exist regarding safety and efficacy. Tranexamic acid has also been used to decrease blood loss by stabilizing clot formation. Because of these concerns, routine tourniquet use for total knee arthroplasty was discontinued by the senior author and routine tranexamic acid administration was commenced. The purpose of this study was to examine total perioperative blood loss with tourniquet use, with tourniquet use and routine use of tranexamic acid, and with tranexamic acid use alone without tourniquet.
METHODS: A retrospective cohort study of 132 patients in 3 groups was performed. The first group underwent total knee arthroplasty with limited tourniquet use only during cementing, the second group had the same protocol but with tranexamic acid administered, and the third group had tranexamic acid but no tourniquet used. Perioperative blood loss was calculated using the Gross formula.
RESULTS: The mean calculated blood loss was highest in the tourniquet-only group at 1,591.39 mL (95% confidence interval [CI], 1,064.97 to 2,117.81 mL), decreased in the second group using tranexamic acid and tourniquet at 1,215.34 mL (95% CI, 1,104.93 to 1,325.75 mL), and was lowest in the third group with tranexamic acid and no tourniquet at 1,007.22 mL (95% CI, 878.78 to 1,135.66 mL).
CONCLUSIONS: Use of a limited tourniquet protocol during total knee arthroplasty resulted in a paradoxical increase in blood loss. Surgeons should consider omitting routine tourniquet use in total knee arthroplasty.
文獻出處：Schnettler T, Papillon N, Rees H. Use of a Tourniquet in Total Knee Arthroplasty Causes a Paradoxical Increase in Total Blood Loss. J Bone Joint Surg Am. 2017 Aug 16;99(16):1331-1336. doi: 10.2106/JBJS.16.00750.
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