摘要
目的根据初次单侧人工全膝关节表明置换术后临时夹闭引流管不同时间点对失血量及膝关节功能的影响,初步探讨引流管夹闭的时机。方法选取2014年5月至2015年12月于莆田学院附属医院行单侧初次全膝关节置换手术的患者共80例,排除膝关节翻修、凝血异常、相对严重的膝关节畸形或者既往术侧下肢骨折病史的患者,术后于不同时间点夹闭引流管,随机分为4组:未夹闭组、夹闭2 h组、夹闭4 h组及夹闭6 h组。对比分析各组患者术后总失血量、术后24 h引流量、血红蛋白丢失量、输血人数、肢体周径的变化、术后第3、6天膝关节活动度、术后第1、3、5天疼痛视觉模拟评分(VAS)、术后2周、3个月美国特种外科医院膝关节(HSS)评分、瘀斑及并发症。计量资料多组比较采用单因素方差分析,组间两两比较采用LSD法,计数资料用卡方检验分析或Fisher确切概率法。结果总失血量(F=267.042)、术后24 h引流量(F=293.997)、血红蛋白丢失量(F=153.010)、术后周径变化(F=192.188)、术后第3天膝关节活动度(F=6.281)、术后第1、3天疼痛视觉模拟评分(F=8.115,F=8.109)4组间差异存在统计学意义(均为P<0.05)。患者输血例数上,夹闭组较不夹闭组呈下降趋势。而术后第6天膝关节活动度、术后第5天疼痛视觉模拟评分、术后2周、3个月HSS评分、术后瘀斑及并发症方面比较差异无统计学意义(P>0.05)。结论研究结果发现人工全膝关节置换术后引流管夹闭4 h是一个比较合适的夹闭时间点,既能减少术后引流量及失血量,降低输血率,又不增加术后短时间疼痛,且不影响膝关节活动及功能。
Objective To evaluate the effects of the different drainage tube clamping time on blood loss and the knee function in primary unilateral total knee arthroplasty and to investigate the optimal drainage tube clamping time .Methods A total of 80 cases of unilateral knee arthroplasty patients from June 2014 to December 2015 in the orthopaedics department of the Affiliated Hospital of Putian University were selected and randomized into four groups：the non-clamping drainage group , the 2 h-clamping drainage group, the 4 h-clamping drainage group and the 6 h-clamping drainage group .The patients with revision or knee malformation , coagulation disorder and fractures were excluded .The total blood loss , the first 24 h drainage volume , haemoglobin loss and the transfusion rate was recorded and analyzed .Lower limb swelling and range of motion（ROM） of knee on the postoperative 3rd day,6th day were examined.The degree of pain was scored by visual analog scale （VAS） on the 1st,3rd and 6th day after the operation.Ecehymosis, complications and the hospital for special surgery knee score （ HSS） two weeks and three months after the operation were observed and recorded .The data were analyzed by chi-square test and LSD test or Fisher exact test.Results There were significant differences in total blood loss , the first 24h drainage,hemoglobin loss, the change of lower limb swelling , ROM on the postoperative 3rd day, VAS on day 1, day 3 after the operation among the four groups （ F=267.042,P〈0.05;F=293.997,P〈0.05,F=153.010, P〈0.05;F=192.188,P〈0.05;F=6.281,P〈0.05;F=8.115,P〈0.05;F=8.109,P〈0.05）.The ratio of transfusion was less in the clamping drainage groups than in the non-clamping drainage .The postoperative ROM on day 6, the preoperative HSS and HSS of two weeks and three months after the operation, VAS at postoperative day 5, ecchymosis and complications showed no significant difference among the four groups （ P〉0.05 ） .Conclusion The postoperative four-hour is an appropriate clamping tim
出处
《中华关节外科杂志（电子版）》
CAS
2017年第6期600-605,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
福建省中青年教育科研项目(JAT170517)
关键词
关节成形术
置换
膝
失血
手术
引流术
Arthroplasty,replacement,knee
Blood loss,surgical
Drainage
