摘要
目的比较放置与不放置引流对人工全膝关节表面置换术（TKA）后康复过程的影响。方法对2007年10月至2008年12月间的30例一期双侧非复杂性TKA手术的骨关节炎患者进行前瞻I生研究。随机一侧放置引流，另一侧不放置引流，自身比较双侧肢体术后疼痛程度、肿胀程度、切口愈合情况、关节功能恢复情况和早期并发症发生情况，并进行统计学分析。结果全部患者获得至少1个月的随访。放置引流侧与未放置引流侧主要时间点对比，术后3d膝关节疼痛（VAS评分：引流侧平均4．7分，非引流侧平均4．9分）、术后6d肢体肿胀程度（髌上和髌下周径差值：引流侧平均1．8cm和0．7cm，非引流侧平均1．7cm和1．0cm）和术后30d膝关节活动度（屈曲度和伸直度差值：引流侧平均12．5°和4．4°，非引流侧平均11．7°和4．20°）经配对t检验差异均无统计学意义（均P〉0．05）；术后早期并发症经Fisher精确检验差异亦无统计学意义（P〉0．05）。结论对非复杂性TKA，引流并不能达到减轻疼痛与肿胀、减少伤口渗出、防止血肿形成进而预防早期感染以及促进康复等作用，故与非引流相比无明显的优势，相反，增加了手术步骤，还有可能增加术后出血和逆行感染的机会，因此，建议不放置引流。
Objective To compare the impact of rehabilitative process of placing drainage versus no drainage during total knee arthroplasty （TKA）. Method A prospective study was performed in 30 osteoarthritic patients who underwent one-stage bilateral TKA between October 2007 and December 2008. For every patient, drainage was randomly placed intra-operatively only on one knee side. Pain VAS scores, extremity swelling, incision healing, recovery of knee joint flexion and extension function and early post- operative complications were compared statistically as a self-control study. Results All patients were followed up for at least one month. Comparing drainage side with non-drainage side, the mean pain VAS scores at Day 3 post-operation were 4. 7 ＋/- 1.8 and 4. 9 ＋/- 1.9 respectively; the mean extremity swelling differences of supra patellar （infra patellar） perimeter at Day 6 post-operation were 1.8 ＋/- 1.7 （0.7＋/-1.0） cm and 1.7 ＋/-1.3 （1.0 ＋/-1.0） cm respectively; the mean flexion （extension） differences at Day 30 post-operation were 12.5 ＋/-21.6 （4.4 ＋/-6.9）° and 11.7 ＋/-23.9 （4. 2 ＋/-6.4 ） ° respectively. There was no obvious statistical difference between placing drainage and no drainage in all the above aspects （ paired t-test, P 〉 0. 05 ）. There was also no statistical difference of early postoperative complications between two groups （ exact Fisher test, P 〉 0.05 ） . Conclusion For unsophisticated TKA, placing drainage had no effect upon reducing the pain, extremity swelling and incision exudation. It also had no effect upon reducing the incidence of hematoma to prevent early infections and promoting rehabilitation. Comparing with no drainage, placing drainage had no obvious advantage. On the contrary, it might complicate the surgical steps and increase the chances of post-operative hemorrhage and retrograde infections. Thus no drainage is recommended in such a kind of operation.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第21期1480-1483,共4页
National Medical Journal of China
关键词
关节成形术
置换
膝
膝关节
人工
引流
Arthroplasty, Replacement, knee
Knee prosthesis
Drainage
