人工全膝关节置换术后是否留置引流对患者疗效影响的对比研究

Influecne of indwelling drainage on curative effect in patients undergoing artificial total knee replacement

目的研究分析骨水泥型膝关节置换术后是否留置引流对患者的临床效果影响。方法回顾性分析温州医科大学附属第二医院60例膝关节骨性关节炎患者,入院后均行骨水泥型初次全膝关节置换术,术后将所有病例随机平分为引流组和非引流组,引流组30例术后留置引流管,非引流组30例不留置引流管。比较观察2组患者术中出血量、术后血红蛋白下降值、VAS评分、住院时间、并发症发生情况。观察术后2、4、8、10、12个月是否有深部关节内感染、膝关节活动度及膝关节KSS评分。结果通过门诊复查方式对所有患者平均随访(14.39±2.74)个月,引流组患者术后血红蛋白下降值显著多于非引流组,差异具有统计学意义(P<0.05),引流组术后5例患者行输血治疗,非引流组术后无病例输血。2组患者术中出血量、术后1、7、14 d的VAS评分、住院时间、术后2、4、8、10、12个月膝关节活动度及膝关节KSS评分比较差异无统计学意义(P>0.05)。所有患者切口均一期愈合,随访期间,所有患者无深部感染及下肢深静脉血栓发生。结论根据本次研究认为膝关节骨性关节炎患者行初次骨水泥型膝关节置换术后不建议留置引流管。

Objective To evaluate the influecne of indwelling drainage on curative effect in patients undergoing artificial total bone cement knee replacement. Methods The retrospective analysis was made on the 60 patients with knee osteoar- thritis admitted to our hospital. They all had bone cement primary total knee replacement after admission, and were ran- domly divided into the drainage group and the non-drainage group after surgery. 30 patients in drainage group indwelled drainage tube while 30 patients in non-drainage group didn＇ t indwell drainage tube. The quantity of bleeding during oper- ation, reduction of hemoglobin after surgery, VAS score, and length of stay and complications were compared between the two groups. Deep infection within knee, knee motion and KSS scores 2,4,8,10, 12 months after the surgery were ob- served. Results The out-patient review was carried out on all patients with （ 14.39 ±2.74） months on average. The re- duction of hemoglobin of the patients in drainage group was significantly heavier than that in non-drainage group and the difference was statistically significant（P 〈0.05）. 5 patients in drainage group had blood transfusion after surgery and no patients in non-drainage group had blood transfusion. There were no significant differences in quantity of bleeding, VAS score 1,7,14 d after surgery,length of stay,knee motion and KSS score 2,4,8,10,12 months after surgery（P 〉0.05）. Primary incision healings were achieved in all patients. No deep infection and deep venous thrombosis were found in other patients. Conclusion The patients with knee osteoarthritis are not suggested to indwell drainage tube after bone cement primary total knee replacement.