COMPARSION OF DEEP VENOUS THROMBOSIS BETWEEN USING READY TO USE STERILE TOURNIQUET AND PNEUMATIC TOURNIQUET AT TOTAL KNEE ARTHROPLASTY SURGERY

Year 2018, , 93 - 97, 23.07.2018

Tansel Mutlu Uygar Daşar

https://doi.org/10.18229/kocatepetip.446846

Abstract

ABSTRACT
OBJECTIVE: We aimed to compare the incidence of deep
vein thrombosis (DVT) after total knee arthroplasty with
the use of sterile elastic tourniquet and the pneumatic
tourniquet.

MATERIAL AND METHODS: From 2005 to 2012, 754
patients undergoing Total knee prosthesis (TKP) were
included in this study. Two groups have been formed
considering patient number, sex and weight. At the
first group, 377 patients have been operated using
pneumatic tourniquet. Sterile tourniquet was also used
in 377 patients at the second group. Both groups were
evaluated for biochemical tests which related to clotting.
Patients showing preoperative DVT or receiving
anticoagulants were excluded. Patients with known
factor deficiency were also excluded from this study.
All patients were operated by same surgeon group and
mean operation time was 60 (45-100) minutes. All of the
patients were mobilised after 19 (10-28) hours. Ankle
flexion and extension exercises was performed after
following motor block. Mean hospitalization time was 5
(3-9) days. Patients were controlled in the first and fourth
weeks after discharge from the hospital. During this
time, patients have been evaluated with clinical findings
and lower extremity doppler ultrasonography for DVT.
Patients who had developed DVT, have been treated by
cardiovascular surgery department.

RESULTS: 165 (21.8%) of the 754 patient had DVT. 124
(32.8%) of these patients was in the first group and 41
(10.8%) was in the second group. 21 (2.7%) patients had
pulmonary embolism, 19 (5%) patients were in the first
group and 2 (0.5%) of these were in the second group. We
observed a significant difference between the groups,
with a frequency of DVT and pulmonary embolism.
(p<0.05). Demographic characteristics were similar in
both groups.

CONCLUSIONS: When pneumatic tourniquet was used,
spasms had been developed in 30-40 centimeter segment
at lower extremity because of circular compressive
forces. On the other hand, this segment was only two
centimeters when sterile tourniquet was preferred.
When affected segment was larger, increasing venous
thrombosis risk were shown because of venous intima
damage. We thought that the use of a sterile tourniquet
decreased the incidence of DVT . 

Keywords

Sterile tourniquet, Total knee arthroplasty, Deep venous thrombosis

TOTAL DİZ REPLASMANI UYGULANAN STERİL HAZIR TURNİKE İLE PNÖMOTİK TURNİKENİN AMELİYAT SONRASI DÖNEMDE DERİN VENTROMBOZU OLUŞUMU YÖNÜNDEN KARŞILAŞTIRILMASI

Abstract

ÖZ
AMAÇ: Total diz replasmanında kullanılan steril elastik
hazır turnike ile pnömotik turnikenin ameliyat sonrası
dönemde gelişebilen derin ven trombozu oluşumuna etkisini
incelemek ve sonuçlarını bildirmek.

GEREÇ VE YÖNTEM: 2005-2012 yılları arasında total diz
replasmanında (TDR) uygulanan 754 hasta çalışmaya
alındı. Hasta sayısı, cinsiyet ve ağırlıkları göz önünde
bulundurularak 2 ayrı grup oluşturuldu. 1. gruptaki 377
vakaya pnömotik turnike, 2. gruba aynı sayıda hazır steril
turnike kullanıldı. Her iki grup pıhtılaşmayı etkileyen
biyokimyasal değerler yönünden incelendi. Pıhtılaşmaya
etkileyen ilaç kullanımı, faktör eksikliği, geçirilmiş derin
ven trombozu veya riskine sahip hastalar çalışmaya
alınmadı. Tüm hastalara aynı cerrahi grup tarafından
operasyon gerçekleştirilmiş olup ortalama operasyon
süresi 60,2±4,12 (45-100) dakika olarak tespit edildi. Tüm
hastalar ortalama19,5±2,18 (10-28) saat sonra mobilize
edildi, motor blok bitiminde ayak fleksiyon-ekstansiyon
hareketleri uygulatıldı. Hastalar ortalama 5,14±0,92 (3-
9) gün hospitalize edildi. Taburcu sonrası 1-4. haftalarda
kontrole çağrıldı. Bu süre zarfında hastalar derin ven
trombozu açısından klinik ve ultrasonografik olarak alt
ekstremite venöz doppler tetkiki uygulandı. Derin ven
trombozu (DVT) pozitif olan hastalara Kardiyovasküler
cerrahi tarafından tedavi başlandı.

BULGULAR: İncelenen 754 hasta içinde 165’ inde (%21.8)
DVT tespit edildi. Bunlardan 1. grupta 124 (%32.8) 2.
grupta ise 41(%10.8) di. Pulmoner emboli 21 (%2.7)
hastada teşhis edilirken 1. grupta 19 (%5) 2. grupta
ise sadece 2 (%0.5) hastada saptandı. İki grup DVT ve
pulmoner emboli gelişimi açısından anlamlı bulundu.
(p<0.05). Her iki grupta incelenen demografik özellikler
benzerdi.

SONUÇ: Pnömotik turnike uygulanması esnasında alt
extremitede yaklaşık 30-40 cm lik bir segmentte sirküler
kompresif güçlere bağlı spazm oluşmaktadır, buna
karşılık hazır steril turnikede bu genişlik yaklaşık 2 cm
dir. Etki altında kalan segment uzunluğu arttıkça damar
intimasında olası hasarlanma nedeniyle venöz tromboz
riskinin artabildiği görülmektedir. Hazır steril turnikelerin
DVT açısından daha az riskli olduğu görülmektedir.

Keywords

steril turnike, total diz artroplastisi, derin ven trombozu

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