Die Auswirkung der Oberschenkelblutsperre auf den Blutverlust in der Knieendoprothetik

Zusammenfassung

Einleitung: Um den Blutverlust in der Knieendoprothetik zu minimieren, wurden eine Reihe von physikalischen Maßnahmen versucht, mitunter die Oberschenkelblutsperre. Es besteht Klärungsbedarf, wann diese geöffnet werden soll.
Patienten und Methode: Unter der Vorstellung, durch eine sorgfältige Blutstillung vor dem Wundverschluss den Blutverlust und damit verbunden die Häufigkeit von Bluttransfusionen reduzieren zu kö nnen, analysierten wir in einer prospektiv-randomisierten Studie im Zeitraum von 1/1996 bis 6/1998 70 konsekutive Knieprothesenimplantationen wegen Gonarthrose (41 Männer, 29 Frauen) eines Operateurs. In Gruppe I wurde die Oberschenkelblutsperre vor, in Gruppe II nach dem Wundverschluss geöffnet.
Ergebnisse: Wir fanden keine statistisch signifikanten Unterschiede zwischen beiden Gruppen beim geschätzten Blutverlust, dem postoperativen Hämoglobin- und Hämatokritabfall und der Häufigkeit der Bluttransfusionen. In Gruppe II sahen wir zwei tiefe Beinvenenthrombosen. Dieser Unterschied war statistisch nicht signifikant.
Schlussfolgerung: Wir kommen zu dem Schluss, dass die Dauer der Oberschenkelblutsperre keinen Einfluss auf den Blutverlust und die Häufigkeit von Bluttransfusionen in der Knieendoprothetik hat.

Abstract

Aim: To reduce blood loss in total knee arthroplasty various physical measures including the use of a tourniquet are recommended. The question of an early tourniquet release is still unsettled.
Patients and method: To confirm our theory that blood loss and need of blood transfusions might be reduced while removing the tourniquet for meticulous hemostasis before wound closure we analysed 70 (41 male, 29 female) consecutive patients with total knee arthroplasty for osteoarthritis performed by a single surgeon in a prospective-randomized study between 1/1996 to 6/1998. In group I the tourniquet was released before, in group II after wound closure.
Results: We couldn't find any significant differences in the estimated blood loss, the decrease of hemoglobin and hematocrit level, and the transfusion need. In Group II we observed two cases of deep vein thrombosis. This difference was not significant.
Conclusion: We conclude that tourniquet release for hemostasis is not an effective tool in reducing blood loss or transfusion need in total knee arthroplasty.

Knieendoprothetik - Oberschenkelblutsperre - Wundverschluss - Blutverlust

Total knee arthroplasty - tourniquet - wound closure - blood loss

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