综合血液管理模式下全膝关节置换引流必要性研究  

Necessity evaluation of drainage in total knee arthroplasty under comprehensive lood management

作　　者：周启云[1] 田华[2] ZHOU Qiyun;TIAN Hua(Department of Orthopedics,Qinghai Provincial People's Hospital,Xining 810007;Department of Orthopedics,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]青海省人民医院骨科,西宁810007 [2]北京大学第三医院骨科,北京100191

出　　处：《中华骨与关节外科杂志》2019年第4期251-257,共7页Chinese Journal of Bone and Joint Surgery

基　　金：北京市科技计划课题(D171100003217001)

摘　　要：背景:膝关节置换术后放置引流被认为能减少关节腔血肿形成、肿胀、疼痛及感染风险,因此,多数关节外科医师习惯在膝关节置换术后常规放置引流。随着围手术期综合血液管理模式的不断完善,围手术期出血量明显减少,加之骨科加速康复理念的普及,膝关节置换术后是否仍常规放置引流管成为争议。目的:分析在综合血液管理模式的基础上,初次全膝关节置换中放置引流对血红蛋白、异体血输血率及术后早期切口并发症的影响,从而评价全膝关节置换术(TKA)中放置引流的必要性。方法:回顾性分析2016年4月至2017年12月我院同一手术医师实施的217例初次TKA患者的临床资料,其中放置引流患者95例,未放置引流患者122例。两组均使用相同手术方式和关节假体,采取同样围手术期管理模式。引流组术后放置负压引流球,术后2h内常规夹闭,16~24h内拔除引流管。非引流组直接缝合伤口。记录两组术前和术后5 d内血红蛋白(Hb)、血细胞比容(HCT),术后异体血输血率、深静脉血栓(DVT)发生率、止痛药物追加例数、手术时间、术后住院时间及术后2个月内切口并发症发生率。结果:非引流组手术时间更短(P=0.028)。两组术后5 d内Hb、HCT水平差异无统计学意义(P=0.465、0.360)。引流组术后平均引流量为(321.4±112.4)ml。两组术后异体血输血率、术后止痛药物追加例数、术后住院时间、切口并发症发生率之间的差异没有统计学意义(P>0.05)。结论:在综合血液管理模式的基础上,初次TKA术后是否放置引流对术后Hb水平和异体血输血率无显著影响,引流不能降低术后早期并发症的发生率。不放引流具有简化手术流程、减少费用、减少医护人员工作负担等潜在优势。Background: Drainage after knee arthroplasty is believed to reduce the risks for hematoma formation, swelling,pain and infection in the joint cavity. Therefore, most joint surgeons are used to routinely place drainage after knee arthroplasty.However, with the continuous improvement of the perioperative comprehensive blood management mode by which the perioperative blood loss has been significantly reduced and the popularization of accelerated rehabilitation, whether the drainage is still routinely placed after knee joint replacement is controversial. Objective: To investigate the effect of drainage on hemoglobin, allogeneic blood transfusion rate and postoperative incision complication of early period in primary total knee arthroplasty so as to assess the nessecity of drainage. Methods: A total of 217 patients undergoing TKA at our hospital were included in this retrospectively study from April 2016 to December 2017 including 95 patients using drainage and 122 patients not. All patients received the operations by one senior surgeon with the same operation method and prosthesis on the same perioperative protocol except drainage. Patients with postoperative negative pressure drainage had the drainage occluded within 2 hours, and had the tube removed between 16 and 24 hours. Patients without drainage had their incision sutured directly. Hemoglobin(Hb)and haematocrit(HCT) levels of pre-operation and 5 days after operation, postoperative transfusion rate, deep vein thrombosis(DVT) rate, analgesic use, length of surgical time, length of postoperative hospital stay and incidence of wound complications within two months after operation were recorded. Results: The operation duration of patients not using drainage was shorter(P=0.028). The drops of Hb and HCT levels within 5 days after operation were not significantly different between the patients with drainage and those without drainage(P=0.465, 0.360). The mean draining amount was(321.4± 112.4) ml in drainage group.There were no significant differences on transfusion r

关 键 词：全膝关节置换 血液管理 引流 

分 类 号：R687.4[医药卫生—骨科学]