骨折内固定术后是否放置引流管的前瞻性队列研究

Prompting drainage tube placement following fracture internal fixation or not： A prospective cohort study

目的观察骨折内固定术后是否放置引流管对患者的影响。方法通过前瞻性队列的方法对2016年3～8月北京积水潭医院创伤骨科接受切开复位内固定手术治疗桡骨远端骨折、胫骨骨折和踝关节骨折的235例患者进行研究，将4个病区分为2组。A、C病区为试验组（123例），操作方法为术中松止血带、严格止血、不放引流；B、D病区为对照组（112例），操作方法为术中不松止血带、常规止血、放引流管。比较两组患者术后住院时间、伤口情况、术后3d的体温、术后部分血常规指标变化、术后疼痛评分等。结果所有患者术后均未出现高热症状，两组患者的术后住院时间[（3．3±1．6）d、（3．7±1．7）d]、伤口发红、周围肿胀情况、血红蛋白、白细胞、中性粒细胞、疼痛指数变化比较差异均无统计学意义（P〉0．05）。结论对于简单骨折的内固定手术，注意手术的微创操作，术中松止血带严格止血，可以不常规放置引流管。

Objective To investigate the effects of drainage tube placement after fracture internal fixation. Methods A prospective cohort study was conducted of the 235 patients who were to undergo open reduction and internal fixation for tibia fracture, distal radial fracture or ankle joint fracture at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from March to August, 2016. Of them, 123 were assigned into an experimental group who were subjected to adequate hemostasis after releasing the tourniquet without drainage following surgery while 112 into a control group who were subjected to conventional hemostasis without relaxing the tourniquet and placement of drainage tubes. The 2 groups were compared in terms of post- operative hospital stay, wound condition, body temperature 3 days postoperatively, counts of hemoglobins, white blood ceils and neutrophils, and postoperative visual analogue scale （VAS） . Results High fever was not observed in all the patients postoperatively. There were no significant differences between the 2 groups in postoperative hospital stay[ （3.3 ± 1.6） d versus （3.7 ± 1.7） d], wound reddening, wound swelling, hemoglobins, white blood cells, neutrophils, or VAS scores postoperatively （ P 〉 0.05） . Conclusion Drainage tube placement is not routinely necessary after internal fixation of simple fractures if surgical invasion is limited and hemostasis is adequate after intraoperative release of the tourniquet.