2020 年第 1 期 第 15 卷

不同切口引流管夹闭时间对全膝关节置换术失血和并发症的影响

Effect of different incision drainage tube clamping time on blood loss and complications of total knee arthroplasty

作者：马庆薇逄冬李佳萍杨帅

英文作者：

单位：哈尔滨医科大学附属第二医院骨科一科150001

英文单位：

关键词：全膝关节置换术；引流管；夹闭时间；膝关节

英文关键词：

• 摘要：

• 【摘要】目的    探讨引流管夹闭时间对全膝关节置换术(TKA)患者失血的影响及其安全性。方法    选取2017年1月至2018年1月哈尔滨医科大学附属第二医院骨科诊治的行TKA的膝关节骨性关节炎患者120例，按照随机数字表法分为A、B、C组，各40例。A组引流管夹闭2 h后开放，B组引流管夹闭4 h后开放，C组引流管夹闭6 h后开放。3组均于术后24 h拔除引流管。记录手术时间、术前血红蛋白、术后血红蛋白下降量及术后24 h引流量，术前、术后24 h髌骨周径，术前和术后3、7 d疼痛视觉模拟量表（VAS)评分，术后3、7 d膝关节活动度，术前和术后1、3个月美国纽约特种外科医院(HSS)膝关节评分，术后并发症发生情况，术前和术后3、6个月步速、步频、跨步长。结果    3组手术时间、术前血红蛋白水平比较，差异均无统计学意义（均P＞0.05）。B、C组术后血红蛋白下降量及术后24 h引流量均明显少于A组［（23±6）、（22±6）g/L比（26±7）g/L，（131±18）、（145±18）ml比（182±18）ml］（均P＜0.05）。C组术后24 h髌骨周径大于A、B组，术后3 d VAS评分高于A、B组（均P＜0.05），3组术后7 d VAS评分比较差异无统计学意义（P＞0.05）。C组术后3 d膝关节活动度及术后1个月HSS膝关节评分均低于B组和A组（均P＜0.05）。3组术后7 d膝关节活动度及术后3个月HSS膝关节评分比较差异均无统计学意义（均P＞0.05）。C组皮下瘀斑、关节肿胀发生率高于A组和B组（均P＜0.05）。C组术后3个月步速、步频均较A组和B组慢，跨步长较A组和B组小（均P＜0.05）；3组术后6个月步速、步频、跨步长比较差异均无统计学意义（均P＞0.05）。结论    引流管夹闭4 h不仅降低引流量，减少术后失血，且不增加关节肿胀等并发症，可促进膝关节功能提早恢复正常，是引流管夹闭的最佳时间选择。

• 【Abstract】Objective    To investigate the effect of drainage tube clamping time on blood loss in patients undergoing total knee arthroplasty（TKA） and the safety. Methods    From January 2017 to January 2018, 120 patients with knee osteoarthritis undergoing TKA in the 2nd Affiliated Hospital of Harbin Medical University were randomly divided into group A, B and C, with 40 cases in each group. After operation, drainage tube was clamped for 2 h in group A, 4 h in group B and 6 h group C, and it was removed 24 h after operation. Operation time, preoperative hemoglobin level, postoperative hemoglobin reduction and postoperative 24 h drainage volume were recorded. Patellar circumference was measured before and 24 h after operation. Pain Visual Analogue Scale(VAS) score and knee joint mobility were assessed before and 3, 7 d after operation. Knee joint was evaluated by Hospital for Special Surgery(HSS) score before and 1, 3 months after operation. Incidences of complications were observed, and the walking speed, step frequency and step length were measured before and 3, 6 months after operation. Results    There were no significant differences in operation time and preoperative hemoglobin level among groups(all P＞0.05). Reduction of hemoglobin and 24 h drainage volume after operation in the group B and C were significantly less than those in the group A［（23±6）,（22±6）g/L vs （26±7）g/L; （131±18）,（145±18）ml vs （182±18）ml］（all P＜0.05）. After operation, the group C showed greater patellar circumference and higher 3 d VAS score than the group A and B（all P＜0.05）; 7 d VAS score showed no statistical difference among groups（P＞0.05）. After operation, the group C showed less 3 d knee joint mobility and 1-month HSS score than the group A and B（all P＜0.05）; 7 d knee joint mobility and 3-month HSS score showed no statistical differences among groups（P＞0.05）. Incidences of subcutaneous ecchymosis and joint swelling in the group C were significantly higher than those in group A and B(both P＜0.05). Three months after operation, walking speed, step frequency and step length in the group C were less than those in the group A and B(all P＜0.05), but the differences were not significant after 6 months(P＞0.05). Conclusion    Drainage tube clamping for 4 h can reduce drainage volume, postoperative blood loss and relieve joint swelling, which promotes the early recovery of knee joint function.