初次全膝关节置换后放置引流管疗效和安全关系的Meta分析  

Efficacy and safety of drainage placement after primary total knee arthroplasty: a meta-analysis

作　　者：唐健 王仁崇 汤中飞 李百川 Tang Jian;Wang Ren-chong;Tang Zhong-fei;Li Bai-chuan(Department of Shoulder and Elbow Surgery,West Branch of Liuzhou Worker’s Hospital,Liuzhou 545001,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]柳州市工人医院西院运动医学及肩肘外科,广西壮族自治区柳州市545001

出　　处：《中国组织工程研究》2018年第23期3751-3758,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:全膝关节置换在治疗膝关节终末期疾病时可以有效缓解患者的疼痛、重建膝关节功能,目前已在临床上广泛应用,但对于全膝关节置换后是否放置引流管目前仍存在一定的争议。目的:通过Meta分析评价是否放置引流对初次全膝关节置换的临床疗效影响及并发症。方法:通过计算机检索PubMed,Embase,Cochrane图书馆,万方数据库及中国知网5个数据库,检索与初次单侧全膝关节置换后是否放置引流装置的所有临床随机对照试验以及半随机对照试验。收集纳入相关研究文献的数据,对能进行合并分析的研究采用Revman 5.3软件进行Meta分析,结局指标包括置换后血红蛋白、输血率、失血量、异体输血量、目测类比疼痛评分、膝关节活动度、膝关节功能评分、并发症以及深静脉血栓发生率。结果与结论:(1)共纳入12篇文献,其中包括9篇随机对照试验,3篇半随机对照试验,总共836例患者。其中引流组为429例,未引流组为407例;(2)Meta分析结果显示:初次单侧全膝关节置换后,与未引流组比较,引流组在置换后血红蛋白[MD=-7.20,95%CI(-11.02,-3.38),P=0.000 2],输血率[RR=1.93,95%CI(1.50,2.49),P<0.000 01],失血量[MD=293.73,95%CI(217.47,369.99),P<0.000 01],异体输血量[MD=284.70,95%CI(77.64,491.76),P=0.007]方面差异具有显著性意义。但是在置换后第1天目测类比疼痛评分[MD=-0.02,95%CI(-0.38,0.34),P=0.92],置换后第7天目测类比疼痛评分[MD=-0.06,95%CI(-0.27,0.15),P=0.86],膝关节KSS评分[MD=0.10,95%CI(-2.03,2.23),P=0.93],膝关节活动度[MD=-2.77,95%CI(-8.27,2.72),P=0.32],并发症[RR=0.77,95%CI(0.57,1.05),P=0.10],深静脉血栓[RR=1.60,95%CI(0.64,3.96),P=0.31]方面,差异无显著性意义;(3)结果提示,初次全膝关节置换后放置引流管会增加置换后失血、输血率以及输血量,但是不会提高膝关节的功能,减轻置换后疼痛以及并发症,因此全膝关节置换后尽量减少放置引流装置。BACKGROUND： Total knee arthroplasty（TKA） has been extensively applied in treatment of advanced knee joint disease, because it can effectively alleviate pain and reconstruct knee function. However, whether drainage is needed after TKA remains controversial. OBJECTIVE： To evaluate the clinical curative effect and complications whether drainage placement after primary TKA by meta-analysis. METHODS： PubMed, Embase, Cochrane Library, Wan Fang and CNKI databases were retrieved for the randomized controlled trials（RCTs） and quasi-randomized controlled trial（q RCTs） concerning whether drainage placement is needed after primary TKA. Data from the relevant studies were collected and analyzed by Revman 5.3 software. The outcome indexes included postoperative hemoglobin, blood transfusion rate, blood loss, allogeneic blood transfusion, Visual Analogue Scale score, range of motion of the knee joint, knee function score, complications, and deep venous thrombosis. RESULTS AND CONCLUSION：（1） Twelve articles were included, including 9 RCT trials and 3 q RCT trials, involving 836 patients（429 cases of receiving drainage, 407 cases receiving no drainage）.（2） The results of meta-analysis showed that the postoperative hemoglobin（MD=-7.20, 95% CI（-11.02,-3.38）, P=0.000 2）, blood transfusion rate（RR=1.93, 95 %CI（1.50, 2.49）, P 〈 0.000 01）, blood loss（MD=293.73, 95%CI（217.47, 369.99）, P=0.000 01）, and allogeneic blood transfusion（MD=284.70, 95%CI（77.64, 491.76）, P=0.007） showed significant differences between groups. However, the postoperative 1 st day Visual Analogue Scale score（MD=-0.02, 95%CI（-0.38, 0.34）, P=0.92）, the 7 th day Visual Analogue Scale score（MD=-0.06, 95%CI（-0.27, 0.15）, P=0.86）, Knee Society Score（MD=0.10, 95%CI（-2.03, 2.23）, P=0.93）, range of motion of the knee joint（MD=-2.77, 95%CI（-8.27, 2.72）, P=0.32）, postoperative complications（RR=0.77, 95%CI（0.57, 1.05）, P=0.10）, and deep venous thrombosis（RR=1.60, 95%CI�

关 键 词：关节成形术 置换 膝 引流术 随机对照试验 META分析 全膝关节置换 假体植入 引流 输血率 异体输血 目测类比疼痛评分 深静脉血栓 膝关节活动度 半随机对照试验 

分 类 号：R318[医药卫生—生物医学工程]