The efficacy of tourniquet use in ankle trauma surgery .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(7):33 Eur J Med Res. 2013 Dec 10;18:55. doi: 10.1186/2047-783X-18-553 randomized controlled trials examining the safety and efficacy of tourniquet use in ankle trauma surgery were included in this meta-analysis. The purpose of this review was to compare operative time, hospital stay, ankle range of motion, postoperative infection rates and the incidence of deep venous thrombosis between patients undergoing surgery with or without the use of a tourniquet. Pooled results indicated that tourniquet use in ankle trauma surgery yielded a significantly longer hospital stay and reduced ankle range of motion. Operative time, postoperative infection rates, and the incidence of deep venous thrombosis were statistically similar between groups.
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نعم = 1
غير مؤكد = 0.5
غير ذي صلة = 0
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يقيّم تقييم معايير الإبلاغ الشفافية التي يبلغ بها المؤلفون عن الخصائص المنهجية والتجريبية للتجربة في المنشور. ينقسم التقييم إلى خمس فئات معروضة أدناه.
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
مؤشر الهشاشة هو أداة تساعد في تفسير النتائج المهمة، وتوفر مقياسًا لقوة النتيجة. ويمثل مؤشر الهشاشة عدد الأحداث المتتالية التي يجب إضافتها إلى نتيجة ثنائية التفرع لجعل النتيجة غير مهمة. يمثل الرقم الصغير نتيجة أضعف ويمثل الرقم الكبير نتيجة أقوى.
لماذا كانت هناك حاجة لهذه الدراسة الآن؟
Tourniquet use in orthopaedic surgery is thought to provide benefits such as improved visualization in the surgical field, shortened operative time, and minimized intraoperative blood loss. However, it may contribute to an increased risk in serious complications, such as pulmonary embolism, superficial wound infection, and acute thrombosis. Despite a number of meta-analyses having been conducted on this topic, the use of a tourniquet in orthopaedic surgery remains controversial. This meta-analysis summarized the results of randomized controlled trials evaluating the safety and efficacy of tourniquet use in ankle trauma surgery.
ما هو سؤال البحث الرئيسي؟
Is the use of a tourniquet safe and effective in ankle trauma surgery?
- 3 randomized controlled trials (n=166) were included in this meta-analysis. Between the three studies, 82 patients were in the tourniquet group and 84 patients were in the non-tourniquet group.
- All 3 included studies reported data on operative time (n=166). Pooled data revealed no significant difference between tourniquet and no tourniquet (MD -5.45 [95% CI -13.98, 3.09]; p=0.21). This meta-analysis was performed using a random-effects model, as heterogeneity was found to be significant (p=0.02; I-squared=73%).
- Pooled data from two studies (n=134) reporting hospital stay indicated that tourniquet use was significantly associated with a longer hospital stay (MD 3.17 [95% CI 1.39, 4.95]; p=0.0005). Heterogeneity was found to be insignificant (p=0.72; I-squared=0%).
- Two studies (n=134) reported ankle range of motion. Via the fixed-effect model, pooled data found a significant difference in ankle range of motion, favouring the non-tourniquet group (MD -5.25 degrees [95% CI -9.61, -0.89]; p=0.02). Heterogeneity between studies was not statistically significant (p=0.51; I-squared=0%).
- With respect to postoperative infection rates (2 studies; 134 patients), there was no significant difference with or without the use of a tourniquet (RR 1.83 [95% CI 0.65, 5.12]; p=0.25). Heterogeneity between studies was not significant for this outcome (p=0.88; I-squared=0%).
- There was no significant difference in the incidence of deep venous thrombosis (2 studies; 134 patients) between the two groups (RR 4.13 [95% CI 0.47, 36.17]; p=0.20). Heterogeneity between studies was not significant for this outcome (p=0.84; I-squared=0%)
ما الذي يجب أن أتذكره أكثر؟
Tourniquet use in ankle trauma surgery resulted in significantly longer hospital stay and reduced ankle range of motion. Operative time, postoperative infection rates, and the incidence of deep venous thrombosis were statistically similar between groups.
كيف سيؤثر ذلك على رعاية مرضاي؟
Results from this meta-analysis suggest that, although safe, the use of a tourniquet in ankle trauma surgery may decrease range of motion and increase length of hospital stay. Additional randomized controlled trials are needed to confirm these findings. Furthermore, future meta-analyses should perform a funnel plot analysis to assess selection bias.
تنويه
هذا المحتوى الموجود في هذه الصفحة هو لأغراض إعلامية فقط وليس الغرض منه أن يكون بديلاً عن المشورة الطبية المتخصصة أو التشخيص أو العلاج. إذا كنت بحاجة إلى علاج طبي، اطلب دائمًا مشورة طبيبك أو اذهب إلى أقرب قسم طوارئ إليك. الآراء والمعتقدات ووجهات النظر التي يعبر عنها الأفراد في المحتوى الموجود في هذه الصفحة لا تعكس آراء ومعتقدات ووجهات نظر أورثوإيفيدنس.
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