McCormack Robert G, Greenhow Robert J, Fogagnolo Fabricio, Shrier Ian
Department of Orthopedic Surgery, University of British Columbia, New Westminster, British Columbia, Canada.
Arthroscopy. 2006 Aug;22(8):889-93. doi: 10.1016/j.arthro.2006.05.004.
A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament (ACL) reconstruction. The usual reason given to justify the use of a drain is to minimize patient pain and stiffness of the knee joint. The purpose of this study was to assess the validity of this approach.
In this study 118 consecutive ACL reconstruction patients were randomized to no drain or a postoperative intra-articular suction drain. Inclusion criteria included a successful ACL reconstruction via either 4-strand hamstrings or bone-patellar tendon-bone autograft as a graft source. The primary outcomes were defined as pain (assessed by pain scores and analgesic counts) and range of motion (ROM) (assessed by loss of flexion and extension compared with the nonoperative leg). An independent statistical analysis was performed.
The 2 groups were comparable with respect to patient demographics, surgical findings, and procedures performed. There were no differences between the treatment groups for the primary outcomes of pain and ROM during the 8-week follow-up period. The study had adequate power to detect a clinically significant difference. Regarding the secondary outcomes, there was a difference in the grade of hemarthrosis between the groups at week 1 but not at week 4 or 8. However, the difference in subjective grade of hemarthrosis at 1 week did not have any effect on the primary outcomes of pain and ROM. During the study period, there were no complications in either group.
The routine use of intra-articular drains after arthroscopic ACL surgery was not supported by this study.
Level II, randomized controlled trial without narrow confidence intervals.
相当一部分外科医生在关节镜下前交叉韧带（ACL）重建术后使用关节内引流管。使用引流管的常见理由是将患者膝关节的疼痛和僵硬程度降至最低。本研究的目的是评估这种方法的有效性。
在本研究中，118例连续的ACL重建患者被随机分为不使用引流管组或术后使用关节内吸引引流管组。纳入标准包括通过4股绳肌或骨-髌腱-骨自体移植物作为移植物来源成功进行ACL重建。主要结局定义为疼痛（通过疼痛评分和镇痛药使用量评估）和活动范围（ROM）（通过与非手术侧腿相比的屈伸丧失来评估）。进行了独立的统计分析。
两组在患者人口统计学、手术结果和所进行的手术方面具有可比性。在8周的随访期内，治疗组在疼痛和ROM的主要结局方面没有差异。该研究有足够的检验效能来检测临床上的显著差异。关于次要结局，两组在第1周时关节积血分级存在差异，但在第4周或第8周时没有差异。然而，第1周时关节积血主观分级的差异对疼痛和ROM的主要结局没有任何影响。在研究期间，两组均未出现并发症。
本研究不支持在关节镜下ACL手术后常规使用关节内引流管。
II级，无狭窄置信区间的随机对照试验。
