初次人工全膝关节置换术后放置引流疗效及安全性荟萃分析

A meta-analysis for the efficacy and safety of drainage after primary total knee arthroplasty

目的 系统评价人工全膝关节置换术（TKA）后放置引流的疗效及安全性.方法 计算机检索Cochrane Library、PubMed、Medline、EMASE、中国生物医学文献数据库、Highwire、CNKI、VIP、万方数字期刊群,搜索国内外有关TKA术后放置引流与否的随机对照研究,采用RevMan 5.1.5软件进行荟萃分析.结果 纳入研究9篇RCT,外文7篇,中文2篇,共计706例膝关节置换,引流组359例,无引流组347例.TKA术后放置引流与不放置引流两组在切口感染例数、深静脉血栓例数、皮肤瘀斑例数、术后第7天Hb下降值、术后第7、14天膝关节疼痛评分、术后膝关节活动度、住院时间方面差异无统计学意义（P＞0.05）,但在总失血量、输血例数、术后3d膝关节周径增加值方面差异有统计学意义（P＜0.05）.结论 初次非复杂TKA术后不常规放置引流可能是更好的选择,但是对于需要大面积松解和矫形的初次TKA依然需要放置引流,骨科医师需权衡利弊.

Objective To evaluate the efficacy and safety of draiange after primary total knee arthroplasty （TKA）.Methods Comparative studies between with and without drainage after primary TKA were retrieved from Cochrane Library,PubMed,Medline,EMASE,CBM,Highwire,CNKI,VIP and Digital Periodicals in Wanfang Data.All randomized controlled trials were included for meta-analysis with RevMan 5.1.5 software.Results A total of 9 studies involving 7 in foreign languages and 2 in Chinese were identified.There were knee replacement （n =706）,drainage （n =359） and non-drainage （n =347）.The results of meta-analysis indicated that no inter-group statistical difference existed in the counts of wound infection,deep venous thrombosis,hemoglobin value decrease at Day 7 post-operation,knee pain at Days 7 and 14 post-operation,post-operative knee range-of-movement or length of hospital stay （P ＞ 0.05）.And there were statistical differences with respects to total blood loss,count of blood transfusions,count of skin ecchymosis,increasing rate of knee circumference at Day post-operation （P ＜ 0.05）.Conclusion Nonroutine placement of drainage after primary uncomplicated TKA may be preferred.However,for extensive release and primary orthopedics,drainage is still necessary.And a surgeon should weigh its pros and cons.