延迟开放引流和常规引流在老年全膝关节置换术后的应用效果研究

Effects of delayed open drainage and conventional drainage on elderly patients after total knee replacement

目的：探讨延迟开放引流和常规引流在老年全膝关节置换术（TKA）后的应用效果。方法将76例初次择期行单侧 TKA 手术的老年患者分为延迟开放组（n ＝32）和常规组（n ＝44），两组患者均由同一组医师完成手术操作，术后常规组患者保持引流管开放，延迟开放组患者先将引流管夹闭至术后12 h 再进行开放，记录两组患者总引流量、异体血输血及术后24 h、72 h 和7 d 体温变化情况，比较两组患者手术前后血红蛋白（Hb）及髌上周径差情况，评估两组患者切口愈合情况及术后2周关节活动度。结果延迟开放组患者引流量[（379.4±132.7）ml]低于常规组[（675.8±149.5）ml]，差异有统计学意义（P ＜0.05）；延迟开放组患者术后 Hb 含量[（92.6±8.2）g/ L]高于常规组[（80.4±9.9）g/ L]，差异有统计学意义（P ＜0.05）；延迟开放组患者异体血输血率为15.6％，显著低于常规组的43.2％，差异有统计学意义（P ＜0.05）；两组患者术后24 h、72 h 和7 d 体温、手术前后髌上周径差和术后关节活动度比较差异未见统计学意义（P ＞0.05）。结论延迟开放引流应用于老年 TKA 术后可有效减少术后失血，降低异体血输血率，不会对患者关节功能恢复产生不良影响，具有较好的近期临床效果。

Objective To investigate the effects of delayed open drainage and conventional drainage on elderly patients after total knee replacement（TKA）. Methods A total of 76 elderly patients underwent primary elective unilateral TKA surgery were divided into delayed opening group（n = 32）and conventional group（n = 44）. The surgery procedures of the two groups were completed by a unified set of physicians. The patients in conventional group were given open drainage tube,while the patients in delayed opening group were given open drainage tube after drainage tube occlusion for 12 h. The total＆nbsp;drainage,allogeneic blood transfusion and temperature changes at 24 h,72 h and 7 d after operation were recorded. The levels of hemoglobin（Hb）and patellar diameter differences of the two groups before and after surgery were compared. The wound healing and postoperative joint activity after two weeks were assessed. Results The drainage volume in the delayed opening group was（379. 4 ± 132. 7）ml,which was lower than that in the conventional group[（675. 8 ± 149. 5）ml],the difference was significant（P 〈0. 05）. The postoperative Hb content of the patients in delayed opening group was（92. 6 ± 8. 2）g / L, which was higher than that in the conventional group[（80. 4 ± 9. 9）g / L],the difference was significant （P 〈 0. 05）. The allogeneic blood transfusion rate of delayed opening group was 15. 6% ,which was lower than that of the conventional group（43. 2% ）,the difference was significant（P 〈 0. 05）. There was no significant difference in the body temperatures at 24 h,72 h and 7 d after operation,diameter difference before and after surgery or postoperative patellar week joint activity between the two groups had no significant（P 〈 0. 05）. Conclusions Delayed open drainage applied to the elderly patients after total knee arthroplasty can effectively reduce the postoperative blood loss and allogeneic blood transfusion rate. It has no adverse effect on the recovery of joint function,and has better short-term clinical results.