直接前方入路全髋关节置换术后是否放置引流管的对比研究

A Study of Drainage After Total Hip Arthroplasty with Direct Anterior Approach:to Use or Not to Use?

目的比较直接前方入路(direct anterior approach,DAA)全髋关节置换术后引流管放置与否的差异性及临床效果。方法选择自2018年1月至2018年12月在中国科学技术大学附属第一医院骨科接受直接前方入路全髋关节置换术患者50例,其中男28例,女22例;左髋27例,右髋23例;年龄29~87岁,平均(56.5±12.6)岁。25例放置引流管,25例未放置引流管,均采用生物型假体,均使用生理盐水20 mL加氨甲环酸1.0 g关节腔注射。引流管组夹闭引流至第2天早上开放,24~48 h拔除引流管。观察术后24 h及第3天的血红蛋白量和红细胞比积、术后疼痛视觉模拟评分(visual analogue scale,VAS)、切口愈合情况及术后1年的髋关节功能评分(Harris评分)。结果两组术后24 h和术后3 d的血红蛋白量和红细胞比积、术后3 d的VAS评分、术后1年的Harris评分组间比较,差异均无统计学意义(P>0.05)。结论对于直接前方入路全髋关节置换,不放置引流管不影响临床效果,不增加并发症的发生率,减少了护理流程,建议常规不用放置引流管。

Objective To compare the difference and clinical effect between drainage tube and non-drainage tube after total hip arthroplasty with direct anterior approach(DAA).Methods From January 2018 to December 2018,a total of 50 cases that had total hip arthroplasty were enrolled.There were 27 left and 23 right hip joints,including 28 males and 22 females.Among them,25 cases had drainage tube and 25 caseshad no drainage tube.Bioprosthesis was used in all cases.All patients accepted articular cavity injectionwith 20 mL saline plus 1.0 g tranexamic acid.The drainage tube group clamped the drainage tube and opened it in the next morning.The drainage tube was removed 24~48 hours later.We compared the levels of hemoglobin and hematocrit at 24 hours and 3 days after operation,pain degree,wound healing and Harris hip score at half a year after operation.Results There were no significant differences in hemoglobin and hematocrit at 24 hours and 3 days after operation,pain degree and Harris score at one year after operation between the two groups(P<0.05).Conclusion For direct anteriorapproach total hip arthroplasty,no drainage tube will not affect the clinical effect,not increase the incidence of complications,reduce the nursing process.It is recommended that drainage tube should not to be placed routinely.