股骨近端抗旋髓内钉固定术后应用负压引流装置产生负面影响的实验研究

Influence of negative pressure drainage on patients after proximal femoral nail antirotation fixation

目的在股骨近端抗旋髓内钉(PFNA)术后使用密闭式负压引流系统引流治疗ITFs的效果具有临床不确定性,此项前瞻性随机对照试验旨在研究应用PFNA固定治疗ITFs术后防止负压引流系统是否对患者有益。方法对60例符合纳入标准应用PFNA固定治疗的粗隆间骨折患者进行随机分组,决定是否在术后安放负压引流装置。在术后第4、10、90天测量视觉模拟量表(VAS),对镇痛药用量、大腿肿胀宽度、伤口状况和感染情况进行评估;同时,评估术后不同时间点血红蛋白、血细胞比容水平、总失血量和输血量。结果引流组的总失血量(579.1±236.71 mL)大于非引流组的总失血量(427.8±239.77 mL;P=0.01);引流组的输血量(443.33±176.30 mL)大于非引流组的输血量(307.83±155.42 mL;P=0.01);与非引流组(1.7±0.72)相比,引流组术后4 d的VAS评分更高(2.3±0.6,P=0.02)。两组在镇痛药用量、大腿肿胀、伤口感染和血肿、住院时间或在转诊后各时间点并发症总例数之间的差异均无统计学意义(P>0.05)。结论在ITFs行PFNA治疗的患者中,引流组的输血需要量和总失血量均高于非引流组;此外引流装置可能对术后伤口状况没有短期益处。

Objective After using proximal femoral nail antirotation(PFNA)fixation to treat femoral intertro-chanteric fractures(ITFs),closed negative pressure drainage systems are often used for drainage,but the clinical effect of this method is uncertain.A prospective randomized controlled trial study was conducted to analyze the negative effects of negative pressure drainage systems after PFNA fixation.Methods Sixty patients with ITFs and underwent PFNA fixation were randomly divided into two groups.Patients in the drainage group were equipped with negative pressure drainage systems after PFNA fixation.At 4,10,and 90 days after the surgery,the visual analog scale(VAS)score,analgesic dosage,thigh swelling width,wound and infection status,hemoglobin,hematocrit level,total blood loss and transfusion blood volume of the patients were recorded to evaluate the prognosis.Results The total blood loss of the drainage group[(579.1±236.7)ml]was greater than that of the non-drainage group[(427.8±239.8)ml;P=0.01].The transfusion blood volume of the drainage group[(443.3±176.3)ml]was greater than that of the non-drainage group[(307.8±155.4)ml;P=0.01].Compared with the non-drainage group,the drainage group had a higher VAS score at 4 days after the surgery(2.3±0.6,P=0.02).There was no difference between the two groups in analgesic dosage,thigh swelling width,wound infection and hematoma,hospital stay and the total number of complications(all P>0.05).Conclusions In the patients with ITFs treated with PFNA fixation,the transfusion blood volume and total blood loss of the patients in the drainage group are higher than those in the non-drainage group.In addition,drainage systems may not have short-term benefits for postoperative wound conditions.