全髋关节置换术后早期引流管夹闭的临床疗效比较

目的 探讨一种既能减少THA术后失血,又不影响其髋关节功能恢复的有效引流方式。方法 将2017年8月～2019年5月在我科首次行单侧全髋关节置换术的120例股骨头无菌性坏死患者随机分成4组,每组30例;实验组:切口引流管夹闭2 h(A组)、4 h(B组)和6 h(C组)后开放,对照组(D组)持续负压引流。记录各组术后0～8 h、9～12 h、13～18 h、19～24 h的切口引流量;术前与术后24 h血红蛋白含量(Hb)差值;各组异体血输血例数;换药次数;术后第1、3天的VAS评分;切口并发症发生率及出院日、术后1个月及术后3个月的髋关节功能Harris评分。结果 实验组术后前8 h切口流量、术前与术后24 h的Hb差值、异体血输血人数及部分切口并发症均较对照组明显减少(P0.05);术后9～12 h、13～18 h、19～24 h四组切口引流量差异无统计学意义(P0.05)。术后第1、3天VAS评分对照组高于实验组,差异有统计学意义(P0.05);四组术后不同时间节点髋关节功能Harris评分差异无统计学意义(P0.05)。结论 全髋关节置换术后早期引流管夹闭能有效减少THA术后失血,减轻患者疼痛、且不影响术后髋关节功能快速康复,有一定的临床应用价值,且术后夹闭4 h效果优于2 h、6 h。

Comparison of clinical effects of early drainage tube clamping after total hip arthroplasty

Objective To explore an effective drainage method that can effectively reduce blood loss after THA,without affecting hip joint recovery.Methods A total of 120 patients with aseptic necrosis of the femoral head who underwent the first unilateral total hip arthroplasty at our department from August 2017 to May 2019 were randomLy divided into 4 groups,with 30 cases in each group.Among the experimental group,the incision drainage tube was clamped for 2 hours(group A),4 hours(group B),and 6 hours(group C)and then opened.And the control group(group D)was treated with continued negative pressure drainage.The incision drainage at 0-8 h,9-12 h,13-18 h,19-24 hours after operation in each group,the difference in hemoglobin content(Hb)before and 24 hours after operation,the number of allogeneic blood transfusions in each group,frequency dressing changes,VAS scores on day 1 and 3,incidence of incision complications and Harris scores on hip function on day of discharge,1 month after surgery,and 3 months after surgery were observed.Results The incision drainage in the first 8 hours after surgery,the difference in Hb before and at 24 hours after surgery,the number of allogeneic blood transfusions,and some incision complications in experimental group were significantly reduced compared with those of the control group(P<0.05).There was no significant difference in incision drainage volume between 9-12 h,13-18 h and 19-24 h(P>0.05).The VAS score in the control group was higher than that in the experimental group on the first and third days after surgery,and the difference was statistically significant(P<0.05).There was no significant difference in the Harris score of hip function at different time points in the four groups(P>0.05).Conclusion Early drainage tube clamping after total hip arthroplasty can effectively reduce blood loss after THA,reduce patient pain and doesn''t afftect the rapid recovery of hip function after surgery.It has certain clinical application value.And the effect postoperative clamping for 4 h is better than that for 2 h and 6 h.