全髋关节置换术后放置闭式负压引流管与不放的对比研究  

Comparison between closed suction drainage and no drainage in primary total hip arthroplasty

作　　者：李新天[1] 王炜[2] 边焱焱[2] 赵彦[2] 肖刻 钱文伟[2] 林进[2] 翁习生[2] LI Xintian;WANG Wei;BIAN Yanyan;ZHAO Yan;XIAO Ke;QIAN Wenwei;LIN Jin;WENG Xisheng(Department of Orthopedics, Aerospace Centre Hospital, Beijing 100049;Department of Orthopedics, Peking Union Medical College Hospital, CAMS＆PUMC, Beijing 100730, China)

机构地区：[1]航天中心医院骨科,北京100049 [2]中国医学科学院中国协和医科大学北京协和医院骨科,北京100730

出　　处：《中华骨与关节外科杂志》2018年第6期412-415,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:全髋关节置换术后是否放置引流管存在争议,提倡者认为放置引流管可以消除血肿,预防感染,反对者认为引流管致出血量增多,有逆行感染的可能。目的:研究初次全髋关节置换术后放置闭合负压引流管与不放对出血量、感染、血肿及血栓形成等的影响。方法:回顾性分析北京协和医院骨科2014年4月至2017年5月行单侧全髋关节置换术的患者200例(按时间顺序选取),其中不放置引流管的患者100例,男33例,女67例,年龄21~80岁,平均(54.0±15.7)岁;放置闭式负压引流管的患者100例,其中男26例,女74例,年龄21~89岁,平均年龄(60.7±14.2)岁;负压引流管于48 h之内拔除,对比两组术前和术后红细胞、血红蛋白、红细胞压积之差,术后住院日、深部感染、伤口感染、伤口血肿、输血率。结果:未放置引流管组和放置闭式负压引流管组性别、身高、体重、疾病诊断及术中出血量没有统计学差异。放置引流管组平均引流量为(324.6±132.3)ml。未放置引流管组术后红细胞下降值、血红蛋白下降值、红细胞压积下降值分别为(0.89±0.41)×10^(12)/L、(27.4±12.2)g/L、0.079±0.036;放置引流管组术后红细胞下降值、血红蛋白下降值、红细胞压积下降值分别为(0.83±0.39)×10^(12)/L、(24.5±11.9)g/L、0.109±0.040,两组3项指标比较,差异无统计学意义(P=0.291、0.095、0.074),术后住院日分别为(6.3±3.3)d、(6.9±4.6)d,差异无统计学意义(P=0.281)。未放置引流管组有2例患者输血,输血率为2%,放置引流管组有4例患者输血,输血率为4%,差异无统计学意义(P=0.407);未放置引流管组关节感染率为0,放置引流管组有1例患者感染,感染率为1%,差异无统计学意义(P=0.316)。放置引流管组有1例患者发生小腿肌间静脉血栓,未放置引流管组无,差异无统计学意义(P=0.316)。两组均未出现伤口血肿、伤口感染及不愈合,均无皮下大片瘀斑,均无下肢肿胀。结�Background： It is controversial on whether closed-suction drainage required or not in total hip arthroplasty, the supporters consider that the drainage can eliminate hematoma, and then prevent infection. The objectors consider that the drainage increases bleeding, and may cause retrograde infection. Objective： To study the effect of closed-suction drainage and no drainage on bleeding, infection, hematoma and thrombosis in primary total hip arthroplasty. Methods： A total of 200 patients who received unilateral total hip arthroplasty from April 2014 to May 2017 in Peking Union Medical College Hospital were selected, including 100 with closed-suction drainage of 26 males, 74 females, aged from 21 to 89 years, average age（60.7±14.2） years and 100 with no drainage of 33 males, 67 females, aged from 21 to 80 years, average age（54.0±15.7）years. The closed-suction drainage was removed within 48 h. Postoperative change of erythrocyte, hemoglobin and hematocrit, length of hospital stay after operation, deep infection, wound infection, wound hematoma, blood transfusion rate were compared between the two groups. Results： There was no statistically difference between the two groups regarding weight,height, gender, diagnosis and intraoperative hemorrhage. The collected drain fluid in closed-suction drainage group was（324.6±132.3） ml. Postoperative change of erythrocyte, hemoglobin, hematocrit in no drainage group wa（s0.89±0.41）×1012/L、（27.4±12.2）g/L、0.079±0.036, compared to that of closed-suction drainage group（0.83±0.39）×1012/L、（24.5±11.9）g/L、0.109±0.040, there was no statistical significance（P=0.291、P=0.095、P=0.074）. There was no statistically significant difference in the length of hospital stay between the two groups（6.27±3.29 vs 6.92±4.59, P=0.281）. The homologous blood trans-fusion rate in no drainage group was 2%, compared to 4% in closed-suction drainage group, there was no significant difference（P=0.407）. Deep infection in no drainage group was 0

关 键 词：关节成形术 置换 髋 闭式负压引流 

分 类 号：R687.4[医药卫生—骨科学]