对初次全髋置换术后不引流的安全性和有效性的观察

Observation on the safety and efficacy of no drainage after primary total hip arthroplasty

目的探讨初次全髋置换术(THA)后不进行引流的安全性和有效性。方法对中南大学湘雅医院骨科2019年1月至2021年12月行初次单侧THA治疗的患者110例的临床资料进行回顾性分析。其中男38例,女72例;年龄(58.90±12.24)(19~84)岁;依据术后是否进行引流将患者分为非引流组(n=46)和引流组(n=64)。非引流组男15例,女31例,年龄(61.26±12.86)(19~84)岁,体重指数=(22.63±3.18)kg/m^(2),合并症包括高血压6例和糖尿病3例。引流组男23例,女41例,年龄(57.20±11.59)(30~80)岁,体重指数=(23.27±3.19)kg/m^(2),合并症包括高血压12例和糖尿病4例。比较两组患者术后第3天的红细胞计数、血红蛋白(HB)和红细胞压积(HCT)的变化,手术时间,失血量,术后感染和下肢深静脉血栓的发生情况以及住院时间。结果非引流组和引流组患者基线资料均衡。非引流组患者的理论失血量和实际出血量分别为(613.95±207.01)ml和(742.21±232.37)ml,显著低于引流组的(740.91±326.99)ml和(937.00±346.64)ml(P=0.014,0.001)。非引流组患者术后HCT和红细胞计数分别下降(6.52±2.33)%和(0.72±0.28)×10^(12)/L,均显著低于引流组的(7.68±3.20)%和(0.85±0.37)×10^(12)/L(P=0.030,0.033)。非引流组患者住院天数为(7.89±2.49)d,显著低于引流组患者的(9.00±2.82)d(P=0.031)。两组患者均未出现伤口不愈合、皮下血肿和大片皮下瘀斑等情况,未见下肢深静脉血栓发生。结论初次THA术后不进行引流安全且不影响疗效。

Objective To investigate the safety and efficacy of no drainage after primary total hip arthroplasty(THA).Methods Clinical data of 110 patients underwent primary unilateral THA in the Department of Orthopedics,Xiangya Hospital of Central South University from January 2019 to December 2021 were retrospectively analyzed.Thirty-eight males and 72 females aged(58.90±12.24)(19-84)years were included.All patients were divided into 2 groups(non-drainage group and drainage group)based on whether postoperative drainage was performed.Non-drainage group(n=46)included 15 males and 31 females,with an age of(61.26±12.86)(19-84)years and a body mass index(BMI)of(22.63±3.18)kg/m^(2),and the combination included 6 cases of hypertension and 3 cases of diabetes.Drainage group(n=64)included 23 males and 41 females,with an aged of(57.20±11.59)(30-80)years and a BMI of(23.27±3.19)kg/m^(2),and 6 patients were associated with hypertension and 4 patients were associated with diabetes.The changes of red blood cell count,hemoglobin(HB)and hematocrit(HCT)on the 3rd day after operation,the perioperative blood loss,operation time and hospitalization time,and the postoperative hematoma,incision complications and deep vein thrombosis(DVT)of lower extremity were recorded and compared between the 2 groups.Results The baseline data of the 2 groups met the requirement of balance and were comparable.The theoretical and the actual bleeding volume of the non-drainage group were lower than that of the drainage group significantly[(613.95±207.01)ml vs.(740.91±326.99)ml,(742.21±232.37)ml vs.(937.00±346.64)ml,P=0.014,0.001,respectively].The postoperative decrease of HCT and the number of red blood cells of the non-drainage group were lower than that of the drainage group significantly[(6.52±2.33)%vs.(7.68±3.20)%,(0.72±0.28)×10^(12)/L vs.(0.85±0.37)×10^(12)/L,P=0.030,0.033,respectively].The length of hospital stay of the non-drainage group was shorter than that of the drainage group significantly[(7.89±2.49)d vs.(9.00±2.82)d,P=0.031].No complications such as wound non-healing,subcutaneous hematoma,large subcutaneous ecchymosis and DVT of lower extremity were found in both groups.Conclusion Non-drainage in primary THA is safe and has no adverse effect on the outcome.