Aksoy Yusuf, Altinel Levent, Köse Kamil Çağri
Department of Orthopaedics and Traumatology, Sandıklı State Hospital, Ayfonkarahisar, Turkey.
Acta Orthop Traumatol Turc. 2011;45(3):190-4. doi: 10.3944/AOTT.2011.2398.
We aimed to determine and compare the effects of intraoperative bleeding control and two hours postoperative drain clamping method on postoperative wound drainage and the need for donor blood transfusion following total knee arthroplasty (TKA).
Seventy-one patients who underwent TKA were randomly assigned into two groups. Fourty-four knees of 32 patients comprised Group A and 51 knees of 39 patients comprised Group B. In Group A, no bleeding control was done and postoperatively, the drain was clamped for 2 hours. Then it was unclamped to begin aspiration after the 2nd hour. In Group B, the bleeding was controlled intraoperatively, and the drain was not clamped after the surgery. Drains were removed 48 hours after the surgery in both groups. Bilateral and unilateral arthroplasty patients were evaluated separately. The groups were compared for their preoperative and postoperative 3-day haemoglobin (Hb) levels, total drainage amount and total number of blood transfusions.
The haemoglobin levels were similar in both groups preoperatively and at the 1st, 2nd and 3rd postoperative days. In Group A, the wound drainage was 696.1±235.4 ml in unilateral TKA patients and was 1010.8±535.5 ml in bilateral arthroplasty patients. In Group B, the wound drainage was 710.1±380.1 ml in unilateral TKA patients and was 878.3±489.6 ml in bilateral arthroplasty patients. The mean number of transfusions was 1.41 units with no significant differences between the groups.
The two hour drain clamping method without intraoperative bleeding control does not seem to affect the amount of blood loss and the need for transfusion when compared to intraoperative bleeding control in total knee arthroplasty patients. Hovewer, it is a simple and feasible method and can be used to decrease the operation time.
我们旨在确定并比较全膝关节置换术（TKA）中术中出血控制和术后两小时引流管夹闭方法对术后伤口引流及异体输血需求的影响。
71例行TKA的患者被随机分为两组。32例患者的44个膝关节组成A组，39例患者的51个膝关节组成B组。A组术中不进行出血控制，术后引流管夹闭2小时，然后在第2小时后松开开始抽吸。B组术中控制出血，术后不夹闭引流管。两组均在术后48小时拔除引流管。双侧和单侧关节置换患者分别进行评估。比较两组术前及术后3天的血红蛋白（Hb）水平、总引流量和输血总数。
两组术前及术后第1、2、3天的血红蛋白水平相似。A组中，单侧TKA患者伤口引流量为696.1±235.4 ml，双侧关节置换患者为1010.8±535.5 ml。B组中，单侧TKA患者伤口引流量为710.1±380.1 ml，双侧关节置换患者为878.3±489.6 ml。平均输血量为1.41单位，两组间无显著差异。
与全膝关节置换患者术中出血控制相比，术中不进行出血控制的两小时引流管夹闭方法似乎不影响失血量和输血需求。然而，这是一种简单可行的方法，可用于缩短手术时间。
