人工全膝关节置换术后放置与不放置引流管对失血情况及关节功能的影响

目的比较单侧初次人工膝关节置换后膝关节腔内是否放置引流管对术后失血量及膝关节功能的影响。方法选取2015年3月—2019年8月因膝关节骨关节炎在我院行单侧人工膝关节置换术患者93例,将2015年3月—2017年7月术后放置引流管的32例设为引流组,将2017年8月—2019年8月术后不放置引流管的61例设为非引流组。比较两组术日、术后第2日、术后第4日血红蛋白、红细胞压积及总失血量;比较两组术后1、2、4 d疼痛视觉模拟评分法(visual analogue scale,VAS)评分、术后关节肿胀程度、皮下淤斑及下肢静脉血栓形成情况;比较两组出院时膝关节活动度和美国纽约特种外科医院(hospital for special surgery,HSS)膝关节功能评分。结果①非引流组术后第2日、第4日血红蛋白、红细胞压积减少程度均明显低于引流组,且非引流组总失血量明显少于引流组,差异均有统计学意义(P<0.05或P<0.01)。②两组下肢深静脉血栓形成、皮肤淤斑发生率及术后VAS评分、关节肿胀程度、膝关节活动度、HSS评分比较差异无统计学意义(P>0.05)。结论人工全膝关节置换后膝关节腔内不放置引流管可减少患者总失血量,且不会增加患膝术后肿胀、疼痛程度及下肢深静脉血栓形成、皮肤淤斑的发生率,并可早期行功能锻炼促进膝关节功能的快速恢复。

Effects of Drainage Versus Nondrainage on Blood Loss and Joint Function after Total Knee Arthroplasty

Objective To investigate the effect of drainage versus nondrainage in the knee joint cavity on postoperative blood loss and knee joint function after primary unilateral total knee arthroplasty(TKA).Methods A total of 93 patients undergoing primary unilateral TKA for knee osteoarthritis in our hospital from March 2015 to August 2019 were enrolled.The drainage group consisted of 32 cases with a drainage tube placed after operation from March 2015 to July 2017.The non-drainage group included 61 patients who underwent operations from August 2017 to August 2019 without drainage tube placed.At 1,2 and 4 d after operation,hemoglobin,hematocrit counts and total blood loss were compared between the two treatment groups.In addition,their pain visual analogue scale(VAS)scores,the grade of knee swelling,the extent of ecchymosis and deep venous thrombosis(DVT)of lower extremities,the range of motion(ROM)of the knee joints as well as the HSS knee score were compared at 1,2 and 4 d after operation.Results①The non-drainage group was observed to have a significantly lower hemoglobin,hematocrit count and total blood loss than the drainage group(P<0.05 or P<0.01).②There was no statistically significant difference in DVT of lower extremities,incidence of ecchymosis,the pain VAS scores,the grade of knee swelling,ROM of the knee joints and the HSS knee score between the two groups(P>0.05).Conclusion The total blood loss was significantly reduced in patients without drainage placed in the knee joint cavity after TKA.It did not increase postoperative swelling of affected knee,pain,DVT of lower extremities and incidence of ecchymosis.In addition,functional exercises could be performed at early stage to promote rapid recovery of knee joint function.