初次髋关节置换术后引流与否的Meta分析

Do we really need wound drainage in hip arthroplasty ? A meta-analysis

目的通过Meta分析比较放置引流对髋关节置换术的疗效及安全性。方法计算机检索Pub Med、EBSCO、The Cochrane Library、万方数据库、中国知网等中英文数据库,检索2000年1月至2015年8月关于髋关节置换术后引流与不引流的临床随机对照研究。按纳入、排除标准进行筛查和质量评估,采用Rev Man 5.2软件进行Meta分析。结果纳入20个研究,2 270例患者,引流组1 134例,不引流组1 136例。Meta分析显示：与不引流组相比,髋关节置换术后引流不能显著减少患者感染率（RR=0.75,95%CI：0.49~1.14,P=0.18）、血肿形成率（RR=0.98,95%CI：0.25~3.91,P=0.98）、深静脉血栓（RR=2.56,95%CI：0.86~7.68,P=0.09）、肺栓塞（RR=2.37,95%CI：0.35~15.94,P=0.38）及疼痛,但显著增加患者输血率（RR=1.36,95%CI：1.58,P〈0.001）、输血量（WMD=0.64,95%CI：0.21~1.07,P〈0.05）及失血量（WMD=277.80,95%CI：118.88~436.73,P〈0.05）。结论髋关节置换术后放置引流管与不放置相比无明显优势。

Objective To explore the efficacy and safety of wound drainage in hip arthroplasty by meta-analysis. Methods The criteria for inclusion and exclusion were formulated. The following databases were searched,including Pub Med,EBSCO,Cochrane Library,Wan Fang Database and China National Knowledge Infrastructure（ CNKI） for studies published during Jan. 2000 and Aug. 2015,and then the randomized trials on hip arthroplasty with wound drainage system and without drainage system were compared. Meta-analysis were conducted with ReviewManager 5. 2.Results A total of 20 studies involving 2 270 participants（ 1 134 drains and 1 136 without drains） were included in our meta-analysis. There was no significant difference in the incidence of wound infections（ RR = 0. 75,95% CI： 0. 49-1. 14,P = 0. 18）,wound hematomas（ RR = 0. 98,95% CI： 0. 25-3. 91,P = 0. 98）,deep vein thrombosis（ RR =2. 56,95% CI： 0. 86-7. 68,P = 0. 09）,pulmonary embolism（ RR = 2. 37,95% CI： 0. 35-15. 94,P = 0. 38） or pain between the two groups. Our results demonstrated blood transfusion（ RR = 1. 36,95% CI： 1. 18-1. 58,P〈0. 001）,transfusion unit（ WMD = 0. 64,95% CI： 0. 21-1. 07,P〈0. 05） and blood loss（ WMD = 277. 80,95% CI： 118. 88-436. 73,P〈0. 05） were more frequent in those who received drains. Conclusion The routine use of wound drainage for hip arthroplasty has no obvious advantages. However,there is a moderate possibility of selection bias and publication bias in this review. More samples and high-quality randomized trials are needed to increase the reliability of evidences.