Der Orthopäde
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Out of all skeletal metastases 30% are located in the spine as are 10% of primary bone tumors, whereby 52% of metastases occur in the lumbar region, 36% in the thoracic spine and 12% in the cervical spine. Patients suffer from local pain caused by irritation of the periosteum due to rapid growth of the tumor or subsequent pathologic fractures which may lead to compression and neurological impairment with paresthesia, paresis and paraplegia. If the diagnosis cannot be confirmed exactly by radiological imaging and laboratory tests, a biopsy should be performed. ⋯ The aim of therapy is pain relief and stabilization by operative and non-operative measures. Therapy is palliative with the aim of pain relief and preservation of mobility. In cases of solitary metastasis a curative operative treatment should be performed.
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The purpose of this study was to evaluate the effect of tourniquet use with constant pressure until wound closure on perioperative blood loss in total knee arthroplasty (TKA). Sufficient patients were included in the study to produce statistically relevant conclusions. In this retrospective case control study 547 patients who were treated with TKA because of osteoarthritis of the knee joint were included and of these 262 patients were operated with the use of a tourniquet (300 mmHg) and 285 without. ⋯ The average perioperative blood loss without tourniquet use was 1.5±0.6 l (range -0.2 to 4.3 l). In contrast patients treated with the use of a tourniquet lost on average only 1.2±0.5 l (range -0.2 to 3.4 l) (p<0.001). The use of a tourniquet reduces the perioperative blood loss in TKA if it is kept tight during the operation.