胫骨高位截骨术放置引流管与否对术后失血量及早期并发症发生的影响

Postoperative blood loss and joint function after high tibial osteotomy with or without drainage tube

目的探讨胫骨高位截骨术中放置引流管与否对术后失血量及早期并发症发生的影响。方法回顾性分析青岛大学附属医院自2017-06—2018-09行初次单侧胫骨高位截骨术的43例膝关节前内侧间室骨性关节炎,21例术中放置引流管(引流组),22例术中未放置引流(未引流组)。比较2组术后1、3 d血红蛋白与红细胞压积,术后1 d隐性失血量、显性失血量、总失血量,术后3 d与术前白细胞、血沉、C反应蛋白差值,术后3 d与术前髌上周径、胫骨结节下缘周径、踝关节周径差值,术后早期并发症发生率,以及术后12个月膝关节HSS评分、膝关节活动度、疼痛VAS评分。结果43例均获得至少12个月随访,随访时间(16.1±2.7)个月。引流组术后3 d与术前髌上周径差值低于非引流组,引流组术后1 d显性失血量大于非引流组,差异有统计学意义(P<0.05);其余指标比较差异均无统计学意义(P>0.05)。结论胫骨高位截骨术中放置引流管与否对术后总失血量、膝关节功能恢复、早期并发症发生无明显影响,虽然放置引流可减轻术后患肢髌上肿胀程度,但也明显增加了显性失血量。

Objective To investigate the effect of intraoperative drainage tube placement in high tibial osteotomy(HTO)on postoperative blood loss and early complications.Methods A retrospective analysis was performed on 43 cases of anterior medial compartment osteoarthritis of the knee after the first unilateral HTO from June 2017 to September 2018 in affiliated hospital of Qingdao University,with drainage group(n=21)and non-drainage group(n=22).The hemoglobin and hematocrit one day and three days after operation,the hidden blood loss,apparent blood loss,total blood loss one day after operation,the difference between three days after operation with preoperative in white blood cell,erythrocyte sedimentation rate,C-reactive protein,the difference between three days after operation with preoperative in patellar diameter,diameter edge of tibial tubercle,ankle diameter,incidence of early postoperative complications,and HSS score,knee range of motion,VAS score 12 months after operation were compared between two groups.Results All the 43 patients were followed up for at least 12 months,follow-up time were(16.1±2.7)months.The peripatellar diameter difference before and 3 d after operation in the drainage group was lower than that of the non-drainage group,and the apparent blood loss 1 day after operation in the drainage group was greater than that in the non-drainage group,with statistically significant differences(P<0.05).There were no statistically significant differences in other indicators(P>0.05).Conclusion The placement of drainage tube during HTO had no significant effect on the total postoperative blood loss,the recovery of knee joint function and the occurrence of early complications.Although the placement of drainage could reduce the degree of postoperative suprapatellar swelling of the affected limb.however,it also significantly increased the amount of apparent blood loss.