Department of Orthopaedic Surgery, Joint Reconstruction Center, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea.
Clin Orthop Relat Res. 2010 Aug;468(8):2168-76. doi: 10.1007/s11999-010-1243-6. Epub 2010 Feb 2.
TKA can involve substantial bleeding, and the issue regarding whether vacuum drainage should be used during TKA continues to be debated as both methods have disadvantages.
QUESTIONS/PURPOSES: We therefore asked whether subcutaneous indwelling vacuum drainage is advantageous over intraarticular indwelling vacuum drainage in terms of blood drainage, bleeding-related complications, and functional outcomes in primary TKA.
We randomized 111 patients undergoing TKAs to have either a subcutaneous indwelling or an intraarticular indwelling catheter and compared the two groups for blood loss (hemoglobin decrease, transfusion requirements, hypotension episode), incidence of wound problems (requirements for dressing reinforcement, oozing, hematoma, hemarthrosis, ecchymosis, infection), and functional outcomes (recovery of motion arc, American Knee Society, WOMAC, and SF-36 scores) at 12 months after surgery.
The mean vacuum drainage volume was less in the subcutaneous indwelling group than in the intraarticular indwelling group (140 mL versus 352 mL). The groups were similar in terms of decreases in hemoglobin after 2 and 5 days (3.0 versus 3.3 g/dL and 3.3 versus 3.7 g/dL, respectively), allogenic transfusion requirements (4% versus 11%), incidence of wound problems, and functional scores.
The data suggest subcutaneous indwelling closed-suction drainage is a reasonable alternative to intraarticular indwelling closed-suction drainage and to no suction drainage.
Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
全膝关节置换术（TKA）可能会导致大量出血，关于在 TKA 过程中是否应使用真空引流的问题仍存在争议，因为这两种方法都有其缺点。
问题/目的：因此，我们想知道在初次 TKA 中，皮下留置真空引流相对于关节内留置真空引流在引流量、与出血相关的并发症和功能结果方面是否具有优势。
我们将 111 例行 TKA 的患者随机分为皮下留置组或关节内留置组，并比较两组的失血量（血红蛋白下降、输血需求、低血压发作）、伤口问题发生率（敷料强化、渗液、血肿、关节积血、瘀斑、感染的需求）和功能结果（运动弧恢复、美国膝关节协会评分、WOMAC 评分和 SF-36 评分）在手术后 12 个月。
皮下留置组的平均真空引流量少于关节内留置组（140ml 比 352ml）。两组在第 2 天和第 5 天的血红蛋白下降（分别为 3.0 比 3.3g/dL 和 3.3 比 3.7g/dL）、同种异体输血需求（4%比 11%）、伤口问题发生率和功能评分方面均无差异。
数据表明，皮下留置闭式负压引流是关节内留置闭式负压引流和不引流的合理替代方法。
一级，治疗研究。欲了解完整的证据水平描述，请参见作者指南。
