全髋关节置换术后引流管不同处理方式的临床比较研究

Comparison of different managements of drainage tube after total hip arthroplasty

目的探讨全髋关节置换(THA)术后关节腔引流管不同处理方式在减少术后失血量及恢复髋关节功能方面的临床效果。方法将自2011-03—2012-08首次行单侧THA的105例随机分为3组:实验组暂时夹闭引流管4 h(A组,n=34)和6 h(B组,n=38)后开放,对照组(C组,n=33)持续引流。记录各组术后8、12、24、48 h的切口引流量,术前、术后24 h、术后48 h血红蛋白含量(Hb)和红细胞压积(Ht)值,异体血输入量,引流管顶端细菌培养,切口并发症发生率以及出院时髋关节功能Harris评分。结果 A、B组术后8 h切口引流量较C组明显减少(P<0.05),但A组与B组差异无统计学意义(P>0.05);术后12、24、48 h 3组切口引流量差异无统计学意义(P>0.05)。A、B组术后24、48 h的Hb与Ht明显高于C组,异体血输入量明显少于C组(P<0.05);但A组与B组差异无统计学意义(P>0.05)。3组术后出院时Harris评分差异无统计学意义(P>0.05),引流管顶端细菌培养均为阴性。结论 THA术后早期短期夹闭引流管对于减少异体血输入量和切口引流量是一种简单可靠的方法,且早期夹闭4 h较6 h更具有临床意义。

Objective To study the clinical value of different managements of the drain after total hip arthroplasty in decrease of the postoperative blood loss and joint function recovery. Methods From Mar. 2011 to Aug. 2012, a total of 105 eases that had total hip arthroplasty were enrolled. Among them, 72 eases experienced temporary occlusion clamping of the drainage tube with 4 h（group A, 34 eases）and 6 h（group B, 38 cases）, 33 eases were in continuous drainage tube（group C）. The levels of hemoglobin and hematocrit at after 24 h and 48 h operation, the blood drainage at 8 h, 12 h, 24 h, 48 h after operation, pain degree, wound healing and Harris hip score were compared. Results The blood drainage in group A and B were decreased obviously than that in group C at 8 h after operation （P 〈0.05）, while there＇s no significant difference between group A and B （P〉0.05）. There＇s no significant difference among the three groups in blood drainage at 12 h, 24 h, 48 h after operation（P〉 0.05）. The levels of hemoglobin and hematocrit in group A and B were apparently higher than that in group C at 24 h and 48 h after operation, while the total volumes of homologous blood transfusion were apparently less than that in group C （P 〈0.05）, while there＇s no significant difference between group A and B （P 〉0.05）. There＇s no significant difference among the three groups in the Harris hip score at discharge （P 〉0.05）. The bacterial culture all were negative at the top of drainage tube. Conclusion Temporary ooelusion clamping of the drainage tube could effectively reduce the blood drainage and control the intra-articular penetration after operation. The temporary occlusion at 4h has more clinically significance than that of the 6 h.