Tourniquet Effect on the Lower Extremity Venous System in the Patients Undergoing Total Knee Arthoplasty

Yıl 2021, , 50 - 56, 03.04.2021

Gökhan Cansabuncu , Fatih Gümüş

https://doi.org/10.29058/mjwbs.781387

Öz

Aim: The aim of the study is to investigate the pathologies related with lower extremity venous system
following total knee arthroplasty (TKA) and to evaluate the effect of tourniquet usage on the venous
vascular system.
Materials and Methods: The study cohort comprised 82 patients who underwent TKA due to primary
knee osteoarthritis and was divided into the patients performed TKA with using tourniquet (Group 1,
n=42 patients) and without using tourniquet (Group 2, n=40 patients). Two groups were compared in
the respect of parameters inluding preoperative great saphenous vein (GSV) diameter, clinical venous
insufficieny level, operation time, tourniquet application time, tourniquet pressure, mean systolic blood
pressure and performed type of anesthesia. Results: No significant difference was determined between the groups in respect of venous thromboembolic disease (VTED. Postoperative
leg swelling was found to be significantly higher in the group 1 (p=0.02). Tourniquet application time >49.5 min [odds ratio (OR) 2.48, 95% confidance interval (CI) 0.48–0.91], tourniquet pressure > 275 mmHg [OR 1.98, 95% CI 0.23–0.84], preoperative GSV reflux > 1 sec [OR 1.23, 95% CI 0.32–0.93], operation time > 65 min [OR 1.13, 95% CI 0.11–0.58] were identified as independent risk factors for leg swelling following TKA
Conclusion: We think that it is very important to individualize the tourniquet application in the orthopedic interventions involving lower
extremity such as TKA and to evaluate tourniquet time, tourniquet pressure and preoperative venous vascular system for avoiding postoperative leg swelling and other related complications.

Anahtar Kelimeler

total knee arthroplasty, tourniquet application, thromboemboli, venous insufficiency, leg swelling

Total Diz Artroplastisi Uygulanan Hastalarda Turnike Kullanımının Alt Ekstremite Venöz Sistem Üzerine Etkisi

Öz

Amaç: Total diz artroplastisi (TDA) sonrasında meydana gelen alt ekstremite venöz sistem kaynaklı
patolojileri incelemek ve cerrahisi sırasında uygulanan pnömatik turnikenin venöz damarların üzerine
olan etkisini değerlendirmektir.
Gereç ve Yöntemler: Primer diz osteoartriti nedeni ile turnike kullanılarak TDA uygulanan 42 (Grup
1) , turnike kullanılmadan TDA uygulanan 40 (Grup 2) olmak üzere toplam 82 hasta retrospektif olarak
değerlendirilip çalışmaya alındı. İki grup arasında preoperatif vena sefana magna (VSM) çapı, klinik
venöz yetmezlik derecesi ve intraoperatif operasyon süresi, turnike uygulama zamanı, uygulanan
turnike basıncı, ortalama sistolik kan basıncı, uygulanan anestezi yöntemi parametreleri kıyaslandı.
Bulgular: İki grup arasında venöz tromboembolik hastalık (VTEH) açısından fark bulunmadı. Grup 1’de
postoperatif bacak ödemi anlamlı derecede yüksekti (p=0.02). Çok değişkenli regresyon analizine göre;
turnike kullanılan hasta grubunda, turnike süresi >49.5 dk [odds değeri (OD) 2.48, 95% güven aralığı
(GA) 0.48–0.91], turnike basıncı (mmHg) >275 mmHg [OD 1.98, 95% GA 0.23–0.84], preoperatif VSM
reflü >1 sn [OD 1.23, 95% GA 0.32–0.93], ameliyat süresi >65 dk [OD 1.13, 95% GA 0.11–0.58] bacak
ödemi gelişimi açısından bağımsız risk faktörü olarak belirlendi.
Sonuç: TDA gibi alt ekstremiteyi ilgilendiren ortopedik girişimlerde turnike kullanımının hastaya göre
bireyselleştirilmesinin; turnike süresi, turnike basıncı ve preoperatif venöz vasküler sistemin detaylı
değerlendirilmesinin, postoperatif bacak ödemi ve diğer komplikasyonlardan kaçınma açısından önem
arz ettiğini düşünmekteyiz.

Anahtar Kelimeler

total diz artroplastisi, turnike kullanımı, tromboemboli, venöz yetmezlik, bacak ödemi

Kaynakça

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