人工膝关节置换术后留置引流与否的对比研究  

Drainage versus nondrainage in total knee arthroplasty

作　　者：张纪[1] 张洪[1,2] 

机构地区：[1]北京积水潭医院矫形骨科,100035 [2]解放军总医院第一附属医院骨科

出　　处：《中华外科杂志》2011年第12期1119-1122,共4页Chinese Journal of Surgery

摘　　要：目的对比人工膝关节置换术后留置引流与否的临床结果。方法将2008年9月至2010年3月56例单侧初次人工膝关节置换术患者分为2组，一组留置引流（27例），一组不留置引流（29例），采用相同的手术技术和术后处理，比较两组患者的失血量、隐性失血量、输血量、输血率、疼痛评分、出院时关节活动度、肢体周径增加、下肢深静脉血栓发生率、感染、血肿形成、伤口愈合不良等临床结果。结果术后失血量有引流组为（1250±487）ml，无引流组为（932±332）ml，两组差异有统计学意义（t=2．877，P=0．006）。人均异体血输血量有引流组为（933±487）ml，明显高于无引流组的（510±443）ml（t=3．406，P=0．001）。输血率有引流组为88．9％，无引流组为62．1％，明显低于有引流组（x^2=5．364，P=0．021）。隐性失血量、肢体周径增加、下肢深静脉血栓发生率、疼痛评分、出院时关节活动度两组无明显差异。两组病例均未出现术后感染、血肿形成、伤口愈合不良等并发症。结论无引流组术后失血量小于有引流组，输血量及输血率也相应降低，且在疼痛评分、出院时关节活动度、肢体肿胀、下肢深静脉血栓发生率等方面，两组病例临床结果相似，膝关节置换术后不常规留置引流可能是更好的选择。本结论尚需大样本随机对照的临床研究进行验证。Objective To compare the clinical outcome of total knee arthroplasty with or without wound drainage. Methods A comparative study involving 56 patients who were accepted primary unilateral total knee arthroplasty, divided into two groups. Group 1 included 27 patients with wound drainage ; group 2 included 29 patients without any drainage. All operations were performed by a single surgeon, and all patients were recovered under the same programs. The mean blood loss, hidden blood loss, volume of transfusion, transfused rate of two groups were compared. Meanwhile, the clinical results of two groups, including pain, swelling, hematoma, infection, range of motion, deep venous thrombosis, and wound healing, were evaluated. Results The average blood loss in group 1 was （ 1250 ± 487 ） ml, which was significantly higher than that of group 2, （932 ±332） ml （t =2. 877 ,P =0. 006）. The volume of transfusion was （933±487） ml in group 1 compare to （510 ±443） ml in group 2 （t =3.406,P =0.001）. Blood transfusion was required in 88.9% of 27 patients managed with a drain compared with 62. 1% of 29 managed without a drain （x^2 = 5. 364 ,P = 0. 021 ）. There was no statistical difference in the hidden blood loss, pain score, swelling, or the range of motion, or in the incidence of deep venous thrombosis, infection, hematoma, and wound problems. Conclusions According to our study, the use of wound drainage provides no apparent advantages after total knee arthroplasty. The blood loss and the need for blood transfusion may decrease significantly in patients without wound drainage after total knee arthroplasty, meanwhile, there were no significant differences in other clinical resuhs between two groups. However, large-scale randomized controlled clinical trials were needed to verify the conclusion.

关 键 词：关节成形术 置换 膝 引流术 对比研究 

分 类 号：R687.4[医药卫生—骨科学]