单侧膝关节表面置换:经皮下引流与关节腔引流及无引流的对照

Unilateral total knee arthroplasty:Comparison among subcutaneous drainage,articular cavity drainage,and no drainage

背景:膝关节表面置换术中是否放置引流以及放置引流的方式,一直都存在争议。目的:在关节腔引流与无引流基础上临床实践了皮下引流,评价皮下引流在单侧膝关节表面置换过程中的价值。方法:通过前瞻性随机对照的方法,将101例拟行单侧膝关节表面置换的患者分为3组,皮下引流组35例,关节腔引流组32例,无引流组34例。分别比较3组患者膝关节表面置换后的引流量、输血量与血红蛋白下降值;并对3组患者的置换后并发症及膝关节功能康复情况进行对比分析。结果与结论:皮下引流组的皮下瘀斑面积(11～30cm2,>30cm2)、置换后3d膝关节周径增加率均小于关节腔引流组及无引流组(P<0.05);皮下引流组输血量、置换后24h引流量、置换后48h血红蛋白下降值均低于关节腔引流组(P<0.05)。置换后肢体疼痛评分、关节屈曲度、1年随访膝关节感染发生率等方面3组差异无显著性意义(P>0.05)。提示单侧膝关节表面置换后放置皮下引流较关节腔引流及无引流有一定优势。

BACKGROUND：Drainage placement and pattern during total knee arthroplasty（TKA） remain controversial.OBJECTIVE：To explore the effect of subcutaneous drainage after unilateral TKA with or without drainage.METHODS：A randomized prospective study was performed.The 101 patients were divided into 3 groups：subcutaneous drainage（n=35）,articular cavity drainage（n=32）,no drainage（n=34）.The blood loss,blood transfusion and hemoglobin reduction among groups were compared.The recovery after surgery and the correlative complications were analyzed.RESULTS AND CONCLUSION：Subcutaneous ecchymosis area（11-30 cm2, 30 cm2） and knee joint diameter increase rate 3 days post surgery were significantly lower in subcutaneous drainage group compared with other groups（P 0.05）;blood transfusion amount,drainage amount 24 hours post replacement,hemoglobin reduction were lower in subcutaneous drainage group compared with articular cavity drainage group（P 0.05）.The pain scores,flexion degree,infection rate during 1-year follow-up were similar among the groups（P 0.05）.Results show that subcutaneous drainage has advantages after unilateral TKA compared with articular cavity drainage or no drainage.