全膝关节置换术后引流管的不同管理方式在膝骨关节炎中的应用效果比较

Comparison of the effect of different management methods of drainage tube in knee osteoarthritis after total knee arthroplasty

目的探讨全膝关节置换(TKA)术后引流管的不同管理方式在膝骨关节炎(KOA)中的应用效果。方法选取2020年10月至2022年6月新乡医学院第一附属医院收治的96例行TKA治疗KOA的患者,根据随机数字表法将其分为三组,各32例。A组TKA术中不放置引流管;B组TKA术中放置引流管,早期夹闭2 h后持续引流;C组TKA术中放置引流管,每2 h中间断夹闭110 min,开放10 min,直至6 h后持续开放。记录三组术前和术后血红蛋白(Hb)、红细胞压积(HCT)、视觉模拟评分法(VAS)评分、患肢周径、膝关节活动度(ROM)、术后引流量、总失血量及并发症发生情况。结果术后三组hb、HCT较术前降低,且B组低于A组、C组(P<0.05)。术后三组VAS评分低于术前,患肢周径长于术前,且B组和C组VAS评分低于A组,患肢周径短于A组(P<0.05)。三组术后总失血量比较,差异无统计学意义(P>0.05);C组术后引流量少于B组,差异有统计学意义(P<0.05)。三组ROM不同时间、组间及交互作用比较,差异有统计学意义(P<0.05)。组内比较:三组各时间点ROM比较,差异有统计学意义(P<0.05);组间比较:术后1、3 d,B组和C组ROM大于A组,差异有统计学意义(P<0.05)。术后A组皮下瘀斑及膝关节肿胀发生率高于B、C组,差异有统计学意义(P<0.05)。结论TKA术后引流管间断夹闭6 h后持续开放,可提高早期关节活动度,减少引流量、疼痛及并发症。

Objective To investigate the effect of different management methods of drainage tube in knee osteoarthritis(KOA)after total knee arthrplasty(TKA).Methods A total of 96 patients with KOA treated with TKA admitted to the First Affiliated Hospital of Xinxiang Medical University from October 2020 to June 2022 were selected and they were divided into three groups according to random number table method,with 32 cases in each group.No drainage tube was placed during TKA in group A.In group B,the drainage tube was placed during TKA operation,and the drainage was continued after two hours of early clamping.In group C,the drainage tube was placed during the TKA operation,which was clamped intermittently for 110 minutes every two hours and opened for 10 minutes until six hours later.Preoperative and postoperative hemoglobin(Hb),hematopoiesis(HCT),pain visual analogue scale(VAS)score,circumference of affected limb,range of motion(ROM)of knee joint,postoperative drainage volume,total blood loss,and complications were recorded.Results After operation,the Hb and HCT of the three groups were lower than those before operation,and those of group B were lower than group A and group C(P<0.05).After operation,the VAS scores of the three groups were lower than those before operation,and the circumference of the affected limb in the three groups were longer than those before operation,and the VAS scores of group B and group C were lower than those of group A,and the circumference of the affected limb of group B and group C were shorter than those of group A(P<0.05).There was no significant difference in total blood loss among the three groups(P>0.05);the postoperative drainage volume of group C was less than that of group B,with statistically significant(P<0.05).There were significant differences in ROM time,between groups and interaction among the three groups(P<0.05).Intra-group comparison:the ROM of the three groups at each time point was compared,(P<0.05).Comparison between groups:the ROM of group B and group C on the 1st and 3rd day after operation were greater than those of group A,with statistically significant(P<0.05).The rate of subcutaneous ecchymosis and knee joint swelling in group A were higher than those in group B and C,the differences were statistically significant(P<0.05).Conclusion Continuous opening of the drainage tube after intermittent clamping for 6 h after TKA can improve early joint motion and reduce drainage flow,pain and complications.