人工全膝关节置换术后是否放置引流管的效果观察

The clinical effects of drainage versus no drainage in total knee arthroplasty

目的探讨放置引流管与不放置引流管对初次单侧人工全膝关节置换术（TKA）术后患者失血量、关节肿胀程度、局部疼痛、关节功能及相关并发症的影响。方法选择210例初次单侧TKA患者为研究对象，按照随机数字表法分为引流组和非引流组，每组105例。引流组在关闭切口前放置引流管，非引流组不放置引流管。分别检测并记录2组患者术前及术后1、3、7d血红蛋白及红细胞压积，计算隐性失血量及总失血量，并记录输血率；记录术后患肢疼痛评分、关节肿胀程度、皮肤淤斑面积、感染以及下肢深静脉血栓形成等并发症发生情况；评估术后1年时膝关节功能情况。并对以上观察指标进行统计学分析。结果引流组总失血量及输血率分别为（1321．25±117．36）ml、23．81％（25／105），非引流组总失血量及输血率分别为（1113．13±114．14）ml、11．42％（12／105），2组比较差异有统计学意义（t=12．455，X2=5．544，P〈0．01或0．05）。2组术后视觉模拟评分、关节肿胀程度、皮肤淤斑面积、感染以及深静脉血栓形成发生率差异无统计学意义（P〉0．05）。2组患者术后1年膝关节功能评分差异无统计学意义（P〉0．05）。结论TKA术后膝关节腔内不放置引流管能降低患者术后的总失血量及输血率，同时并不会增加术后膝关节的肿胀及疼痛程度，不影响术后膝关节功能恢复、术后深静脉血栓形成及感染风险，值得推广应用。

Objective To compare the clinical effects of drainage versus no drainage in blood loss , degree of pain, swelling of the knee, ecchymosis, infection rate, venous thrombus and Knee Society Scores after total knee arthroplasty（TKA）. Methods Total 210 patients who accepted primary unilateral TKA were divided into 2 groups by random digits table method, drainage group and non-drainage group, each group had 105 patients. A drainage was put into the articular cavity before the closure of the incision in drainage group and no drainage was used in non-drainage group. The hemoglobin and hematocrit before operation and 1, 3, 7 day after operation were recorded. Total blood loss and hidden blood loss was calculated and the rate of the patients who need blood transfusion was recorded, too. The degree of pain,swelling of the knee, ecchymosis, infection rate, deep venous thrombosis of lower limb and Knee Society Scores 1 year after the operation were examined and recorded. All these indicators were analyzed, Results The total blood loss and the blood transfusion rate of drainage group were （1 321.25＋ 117.36） ml, 23.81%（25/105）. The total blood loss and the blood transfusion rate of non-drainage group were （1 113.13±114.14） ml, 11.42%（12/105）. There was statistically significant difference between two groups（t=12.455, P 〈 0.01; A2= 5.544, P 〈 0.05）. There was no statistically significant difference in the degree of pain, swelling of the knee, ecchymosis, infection rate, deep venous thrombosis of lower limb, and Knee Society Scores between two groups （P〉 0.05）. Conclusions The total blood loss and blood transfusion rate may decrease significantly in patients without wound drainage after TKA. And without wound drainage had no impact on other clinical results like the degree of pain, swelling of the knee, ecchymosis, infection rate, deep venous thrombosis of lower limb and Knee Society Scores postoperative. Consequently, TKA without wound drainage is safe and is worth for clinical application.