切口闭合引流对膝关节置换术近期安全性影响的系统评价

Systematic review of the earlier safety of closed suction drainage for knee arthroplasty

目的比较全膝关节置换术中切口放置闭合引流与不引流对手术后近期安全性的影响。方法收集所有关于比较全膝关节置换术中切口放置闭合引流与不引流对手术疗效影响的随机和半随机对照试验，对其逐个进行质量评价，作系统评价。结果共纳入12篇随机对照研究，包括1122例患者，1191例观察对象，纳入研究的方法学质量差异较大。切口引流与不引流的全膝关节置换术后切口感染率及下肢深静脉血栓发生率无统计学差异（P=0．62和P=0．94）。在术后切口血肿发生率及术后切口持续渗液等方面，术后放置引流与不放置引流之间差异无统计学意义（P=0．19和P=0．07）。在术后输血患者数方面，膝关节置换术后引流组有更多的患者需要输血（P=0．0006）。关于术后膝关节功能，两组间差异无统计学意义。结论根据本系统评价的结果，无充分的证据支持膝关节置换术后常规放置闭合引流这一措施。在术后切口血肿、深静脉血栓发生率及术后切口持续渗液等方面，术后放置引流与不放置引流之间无统计学差异。相反，术后放置引流增加了术后患者异体输血的几率。在术后切口感染和膝关节功能方面，尽管本系统评价得出两组间无统计学差异，但因为本系统评价和所纳入的研究的缺陷，要得出更可靠的结论，尚需更多大样本、长期随访、使用统一膝关节功能评价指标的RCT以增加证据的强度。

Objective To evaluate the earlier safety of closed suction drainage systems for knee arthroplasty. Methods All randomised or quasi-randomised trials comparing the use of closed suction drainage systems with no drainage systems for all types of knee arthroplasty were searched. The trials＇ quality were assessed, and data was extracted. Where appropriate, results of comparable studies were pooled. Results Twelve studies involving 1122 participants with 1191 surgical wounds were identified. The methodology of the studies identified and included in the analysis varied considerably. Pooling of results indicated no statistically significant difference in the incidence of wound haematoma, dehiscence or deep vein thrombosis between those allocated to drains and the un-drained wounds. Blood transfusion was required more frequently in those who received drains. No difference between the groups was seen with respect to wound infection and the range of movement of the joint after surgery. Conclusions There is insufficient evidence from randomised trials to support the routine use of closed suction drainage in knee arthroplasty. It results in an increase in the number of patients requiring blood transfusion. However, because of the poor trial methodology of many of the studies and the inadequate reporting of outcomes, further randomized trials on this topic are justified.