全膝关节置换术后引流对血红蛋白下降和并发症的影响

Effects of drainage on postoperative hemoglobin decrease and complications after total knee arthroplasty

背景:全膝关节置换术(total knee arthroplasty,TKA)的开展在我国逐年增多,手术引起的血液成分丢失有多种机制,引流失血只是其中的一个因素。放置引流是否增加血红蛋白(hemoglobin,Hb)的丢失尚存争议。目的:了解单侧TKA和双侧一期TKA引起Hb下降的不同程度,以及放置引流管与否对Hb下降水平及并发症发生率的影响。方法法:选取2011年1月至2011年12月在北京协和医院骨科进行单侧和双侧一期TKA的268例患者,其中单侧TKA引流组(A组)106例,单侧TKA非引流组(B组)49例,双侧一期TKA引流组(C组)62例,双侧一期TKA非引流组(D组)51例。分别于术前和术后1 d、3 d、7 d进行全血细胞分析,记录Hb水平。记录引流量和异体输血量、疼痛和功能评分以及并发症发生情况。结果:全部获得随访,随访时间48~60个月,平均56.2±7.3个月。各组均在术后3 d时Hb下降达到最大程度。A组与B组患者、C组与D组患者在术前疼痛评分、术后1个月疼痛评分,膝关节术前活动度、术后活动度(1个月,1年)方面均无统计学差异。A组平均引流量为(347.2±85.3)ml,C组平均引流量为(509.4±127.5)m(lP<0.01)。A组17例(20.8%)需要异体输血,平均每例输血(243.2±45.4)ml;B组9例(21.4%)需要输血,平均每例输血(162.9±34.2)ml;C组55例(73.3%)需要输血,平均每例输血(618.6±80.3)ml;D组46例(80.4%)需要输血,平均每例输血(470.6±68.7)ml。A组与B组的并发症发生率无统计学差异(12.26%vs.18.37%,P=0.311)。D组的并发症发生率显著高于C组(12.90%vs.33.33%,P=0.009)。结论:放置引流与否对于单侧TKA或双侧一期TKA的术后Hb水平下降、异体输血率和输血量均无显著性影响,而单侧TKA的异体输血率远低于双侧一期TKA。不放置引流增加TKA的围术期并发症发生率,特别是在双侧一期TKA。

Background： Total knee arthroplasty（TKA） has been increasing in recent years in China. Blood loss can be caused by various mechanisms and drainage might be one of them. Whether drainage is necessary or not is still a controversy.Objective： To compare the degree of hemoglobin dropping between unilateral and simultaneous bilateral TKA and to evaluate the effect of drainage on the hemoglobin dropping and complications. Methods： A total of 268 patients underwent TKA in our hospital in 2011, either unilaterally（155 patients, 106 with drainage as group A and 49 without drainage as group B） or bilaterally（113 patients, 62 with drainage as group C and 51 without drainage as group D） without other procedure.Full blood analysis was taken preoperatively and on 1, 3, and 7 days postoperatively. Hemoglobin level was recorded. The draining amount, blood transfusion, pain and function scores and complications were also recorded. Results： The mean follow-up period was（56.2±7.3） months in all the patients（range, 48-60 months）. Hemoglobin level reached the lowest on the3 rdday postoperatively. There was no significant difference in pain score or range of motion of the knee either preoperatively or postoperatively between group A and B, between group C and D. The average draining amount was（347.2±85.3） ml in group A and（509.4 ± 127.5） ml in group C（P〈0.01）. Blood transfusion was needed in 17 patients（20.8%） in group A, 9（21.4%） in group B, 55（73.3%） in group C and 46（80.4%） in group D. The mean transfusion was（243.2±45.4） ml,（162.9±34.2） ml,（618.6±80.3） ml and（470.6±68.7） ml, respectively. There was no significant difference in the incidence of complications between group A and group B（12.26% vs. 18.37%, P=0.311）, while the complication rate of group D was significantly higher than that of group C（33.33% vs. 12.90%, P=0.009）. Conclusions： Draining does not affect the hemoglobin dropping level or the necessity or amount of blood transfusion. The complication rate will increase in patients without drainage, especially in those with one-stage bilateral TKA.