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

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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