全髋关节置换术后是否留置引流管及拔管时间对隐性出血及功能恢复的影响

目的:研究比较全髋关节置换术(total hip arthroplasty,THA)术后是否留置引流管及拔管时间对隐性出血及功能恢复的影响。方法:自2017年7月至2018年6月选取初次行THA术的123例患者作为研究对象,根据是否留置引流管及拔管时间分为3组,A组41例THA术后不放置引流管,男24例,女17例,年龄53～77岁;B组41例THA术后放置引流管24 h拔除,男26例,女15例,年龄55～74岁;C组41例THA术后放置引流管48 h拔除,男25例,女16例,年龄52～75岁;比较各组术后72 h疼痛VAS评分,术后总失血量和隐性失血量,开始功能锻炼时间;记录各组术后肢体肿胀等发生率。患者出院后均随访1年以上,采用Harris髋关节评分评价术后1年髋关节功能康复程度。结果:A、B、C组隐性失血量分别为(513.6±25.3)、(521.7±33.4)、(519.3±29.8) ml,差异无统计学意义(P0.05)。3组术中失血量差异无统计学意义(P0.05)。B、C组术后显性失血量大于A组(P0.05)。3组患者术前、术后72 h的VAS评分比较差异均无统计学意义(P0.05)。A组术后下床时间短于B、C组(P0.05),B组术后下床时间短于C组(P0.05)。3组术后1年Harris髋关节评分均明显高于术前(P0.05)。3组术前、术后1年Harris髋关节评分比较差异均无统计学意义(P0.05)。A、B、C组并发症发生率差异无统计学意义(P0.05)。结论:THA术后是否留置引流管及拔管时间对隐性失血量及功能恢复无明显影响,但术后不放置引流管可减少术后显性失血,患者术后6 h即可下床,更利于患者恢复及护理。

Effect of indwelling drainage tube and extubation time on recessive hemorrhage and functional recovery after total hip arthroplasty

Objective: To study and compare the effect of indwelling drainage tube and extubation time on occult hemorrhage and functional recovery after total hip arthroplasty(THA).Methods: From July 2017 to June 2018,123 patients who underwent THA in our hospital for the first time were selected as the subjects of study. According to whether the drainage tube was retained or not and the time of extubation,they were divided into three groups:in group A,41 patients (24 males,17 females,age 53 to 77 years) did not put drainage tube after THA;in group B,41 patients were removed 24 hours after THA,26 males and 15 females,aged 55 to 74 years;in group C,41 patients were removed 48 hours after THA,25 males and 16 females,aged 52 to 75 years. The VAS score of pain 72 hours after THA,the total and recessive blood loss,the time of starting functional exercise,and the incidence of postoperative limb swelling were recorded. All the patients were followed up for one year after discharge. Harris hip score was used to evaluate the degree of hip function recovery one year after operation.Results: The occult blood loss of group A,B and C were(513.6±25.3),(521.7±33.4),(519.3±29.8) ml,respectively,with no significant difference(P>0.05). There was no significant difference in blood loss in operation among the three groups(P>0.05). In group B and C,the postoperative apparent blood loss was more than that in group A(P<0.05). There was no significant difference in VAS scores of the three groups before and 72 hours after operation(P>0.05). The time of getting out of bed in group A was shorter than that in group B and C (P<0.05),and that in group B was shorter than that in group C(P<0.05). The Harris hip score at 1 year after operation of the three groups was significantly higher than that of before operation (P<0.05). There was no significant difference in Harris hip score before and after operation among three groups (P>0.05). There was no significant difference in the incidence of complications among three groups(P>0.05).Conclusion: Whether the drainage tube is left or not and the time of extubation have no significant effect on the latent blood loss and functional recovery after THA,but without drainage tube after THA can reduce the apparent blood loss,patients can get out of bed at 6 hours after THA,which is more conducive to the recovery and nursing of patients.