全膝关节置换术后不同引流方式的临床对比研究

目的 探讨人工全膝关节置换术后不同引流方式对临床疗效的影响.方法 将2010年10月至2012年11月55例接受单侧初次人工全膝关节置换患者分为三组:引流自体血回输组25例、延迟开放引流组12例、常规引流组18例.各组采用相同的手术技术和术后处理,比较术后总引流量(包括术中开放止血带止血时的出血量),异体血输血情况,术后第1、3、7天体温,手术前后血红蛋白值,肢体肿胀情况,伤口愈合质量和术后关节功能.结果 引流自体血回输组平均引流量为(799.2±196.7) ml,明显多于其他两组；延迟开放引流组平均引流量为(381.7±129.2) ml,明显少于常规引流组(666.1±155.0) ml.常规引流组术后第1天血红蛋白平均为(81.33±9.86) g/L,引流自体血回输组平均为(91.96±9.57)g/L和延迟开放引流组平均为(91.50±7.92) g/L,较常规引流组明显升高,差异有统计学意义；而引流自体血回输组与常规引流组的差异无统计学意义.常规引流组有8例患者(44.4％)术后接受异体血输注,明显多于引流自体血回输组(4例,16.0％)和延迟开放引流组(2例,16.7％),差异有统计学意义；引流自体血回输组与常规引流组的差异无统计学意义.引流自体血回输组术后第1、3、7天最高体温明显增高,与其他两组的差异有统计学意义.术后肢体肿胀、伤口愈合质量和术后关节功能三组的差异无统计学意义.结论 延迟开放引流可以减少术后显性失血,降低异体血输注率,与自体引流血回输相比,降低术后发热和额外费用,带来更大的临床收益,值得进一步探讨和应用.

A comparative study on different postoperative drainage ways in total knee arthroplasty

Objective To compare the clinical outcomes of different drains in total knee arthroplasty. Methods Fifty-five patients, who had accepted primary unilateral total knee arthroplasty from October 2010 to November 2012, were included in the comparative study. Based on different drainage ways, 25 patients were arranged into autotransfusion drain group, 18 into routine drain group, and 12 into delayed drain group. Same operative procedure and postoperative care were provided to all patients. The total amount of postoperative drainage (including intraoperative blood loss), information of allogenic blood transfusion, body temperatures of patients on postoperative 1st, 3rd, 7th day, pre- and post-operative hemoglobin level, and postoperative swelling, wound healing quality and range of motion were recorded and compared. Results The amount of drainage was significantly more in autotransfusion drain group (799.2±196.7ml)than those in other two groups (381.7±129.2 ml in delayed drain group and 666.1±155.0ml in routine drain group). The postoperative hemoglobin level in delayed drain group (91.50±7.92 g/L)was similar to that in autotransfusion group(91.96±9.57 g/L), while significantly higher than that in routine drain group(81.33±9.86 g/L). The highest body temperature of patients in autotransfusion drain group was higher than those in other two groups. Allogenic blood transfusion was performed in 8 patients (44.4%) in routine drain group, 4 patients (16.0%) in autotransfusion drain group and 2 patients (16.7%) in delayed drain group. There were no differences between groups in swelling, wound healing quality, and range of motion. Conclusion Delayed release of drain in total knee arthroplasty could reduce blood loss, chances of allogenic blood transfusion and postoperative fever, and extra cost, which can bring more benefits to patients.