Mengal B, Aebi J, Rodriguez A, Lemaire R
Service d'Orthopédie et de Traumatologie, CHU du Sart-Tilman, 4000 Liège, Belgique.
Rev Chir Orthop Reparatrice Appar Mot. 2001 Feb 1;87(1):29-39.
Drainage of the operative wound following total hip or knee replacement (THR, TKR) is usually performed to avoid hematoma formation. A certain amount of blood is lost through the drain. The necessity of wound drainage has been questioned, with a view towards blood saving, although most surgeons have not abandoned drainage for fear of local complications. A prospective randomized study was undertaken to compare drainage and non-drainage following THR/TKR in terms of blood-saving and local complications.
A total of 256 patients undergoing primary THR (152) or TKR (104) were randomly allocated to undergo either suction drainage or no drainage of the wound: there were 76 drained and 76 non-drained THR's, 52 drained and 52 non-drained TKR's. Blood loss was calculated in each patient from the postoperative drop in hematocrit values; the amounts of blood lost intra-operatively and in the drain were also recorded, as was the number of blood units transfused in each patient. Swelling, hip or knee range of motion and wound healing were monitored over the first 6 weeks after operation, and any local or systemic complication was recorded.
No significant difference was noted between drained and non-drained THR's/TKR's regarding swelling, recovery of hip or knee motion, wound healing, other local or systemic complications. Following THR, no significant difference was noted between calculated blood losses or transfusion requirements in drained versus non-drained patients. Patients with drains lost on average 1 942 ml of blood versus 1 766 ml for non-drained patients; they received on average 1.18 units of transfused blood versus 1.32 units for patients without drains. The differences are not significant. Following TKR, total blood loss was significantly higher in non-drained than in drained patients (1 983 ml versus 1 590 ml) and the amount of blood transfused was also significantly higher in non-drained patients (0.98 unit versus 0.54 unit).
Following primary hip or knee arthroplasty, the use of wound drainage did not lead to increased blood loss, and non-drainage did not lead to significant wound healing problems but did not reduce blood loss and transfusion requirements. It was even associated, following TKR, with greater blood loss and transfusion. Such data may therefore be used to support drainage as well as non-drainage following THR or TKR. Avoiding drainage may be interesting in terms of cost, but the benefit is marginal; it also eliminates one possible source of retrograde wound infection. Systematic wound drainage following THR or TKR is essentially a tradition. This study shows that it can safely be dispensed with in a number of cases.
全髋关节或膝关节置换术（THR，TKR）后进行手术伤口引流通常是为了避免血肿形成。会有一定量的血液通过引流管流失。尽管大多数外科医生因担心局部并发症而未放弃引流，但伤口引流的必要性受到了质疑，目的是节省血液。进行了一项前瞻性随机研究，以比较THR/TKR后引流与不引流在节省血液和局部并发症方面的情况。
共有256例行初次THR（152例）或TKR（104例）的患者被随机分配接受伤口负压引流或不引流：76例引流和76例不引流的THR患者，52例引流和52例不引流的TKR患者。根据术后血细胞比容值的下降计算每位患者的失血量；还记录了术中及引流管中的失血量，以及每位患者输注的血液单位数。在术后前6周监测肿胀、髋关节或膝关节活动范围及伤口愈合情况，并记录任何局部或全身并发症。
在肿胀、髋关节或膝关节活动恢复、伤口愈合、其他局部或全身并发症方面，引流与不引流的THR/TKR患者之间未发现显著差异。THR后，引流组与不引流组患者在计算的失血量或输血需求方面未发现显著差异。有引流管的患者平均失血1942毫升，无引流管的患者平均失血1766毫升；他们平均输注1.18单位血液，无引流管的患者平均输注1.32单位血液。差异不显著。TKR后，不引流患者的总失血量显著高于引流患者（1983毫升对1590毫升），不引流患者的输血量也显著更高（0.98单位对0.54单位）。
初次髋关节或膝关节置换术后，使用伤口引流不会导致失血量增加，不引流也不会导致明显的伤口愈合问题，但不会减少失血量和输血需求。甚至在TKR后，不引流与更多的失血和输血有关。因此，这些数据可用于支持THR或TKR后的引流及不引流做法。从成本角度来看，避免引流可能是有意义的，但益处不大；它还消除了一个逆行伤口感染的可能来源。THR或TKR后系统的伤口引流本质上是一种传统做法。本研究表明，在许多情况下可以安全地省去引流。
