Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Street, Bangkoknoi district, Bangkok, Thailand.
Arch Orthop Trauma Surg. 2012 Jul;132(7):1059-63. doi: 10.1007/s00402-012-1501-z. Epub 2012 Mar 13.
Total knee arthroplasty (TKA) is a common procedure that has a risk of significant blood loss and blood transfusion, and carries a substantial risk for immunologic reactions and disease transmission. Drain clamping is a popular method that is applied to reduce blood loss after TKA. However, the clamping protocol remains controversial. Therefore, we established a new protocol, 3-h interval clamping, and compared the bleeding control efficacy of this protocol following TKA with the non-clamping technique.
Between March and July 2008, we enrolled 100 patients (100 knees) who underwent uncomplicated TKA using a minimally invasive surgical technique. The patients were randomly assigned into two groups based on the draining protocol: non-clamping (group A) and 3-h interval clamping (group B). For group A, a vacuum drain was connected to a container and was run continuously during the first postoperative day, whereas the vacuum was stopped twice (for ~3 h each time) for group B. Demographic characteristics and clinical data were collected, including the levels of hemoglobin and hematocrit, the total blood loss volume, the number of patients who required a blood transfusion, and any complications that developed. The perioperative data were compared between the two groups.
The drainage blood volume in the interval-clamping group (group B) was significantly lower than that in the non-clamping group (group A) during the first 48 h following the procedure (p < 0.001 and p = 0.005 for first and second postoperative days, respectively). The mean fall in hemoglobin levels at 12 h in the interval-clamping group (2.8 ± 0.9 g/dL) was also lower than in the non-clamping group (3.2 ± 0.8 g/dL). In the 3-h interval clamping protocol, the number of patients requiring a transfusion was 2.2 times less than the number in the non-clamping protocol, but was not significantly different (odds ratio = 2.20, p = 0.24), and the significant predictor of blood transfusion was the preoperative hemoglobin level (odds ratio = 7.73, p < 0.001). No wound infection or clinical venous thromboembolisms were detected in our study.
The 3-h interval clamping is a newly developed protocol for reducing blood loss after TKA. The protocol lessens the decrease in postoperative hemoglobin levels. This protocol can be applied easily without increasing clinical thromboembolic events and wound complications.
全膝关节置换术（TKA）是一种常见的手术，存在大量失血和输血的风险，并且存在免疫反应和疾病传播的巨大风险。引流夹闭是一种常用于减少 TKA 后失血的常用方法。然而，夹闭方案仍存在争议。因此，我们建立了一种新的 3 小时间隔夹闭方案，并将其与非夹闭技术在 TKA 后的止血效果进行了比较。
2008 年 3 月至 7 月，我们纳入了 100 例（100 膝）接受微创技术的单纯 TKA 患者。根据引流方案将患者随机分为两组：非夹闭组（A 组）和 3 小时间隔夹闭组（B 组）。对于 A 组，将真空引流管连接到一个容器中，并在术后第 1 天持续引流，而 B 组则每隔 3 小时夹闭引流管两次（每次约 3 小时）。收集患者的人口统计学特征和临床数据，包括血红蛋白和血细胞比容水平、总失血量、需要输血的患者人数以及任何发生的并发症。比较两组围手术期数据。
术后第 1 天至第 48 小时，夹闭组（B 组）的引流血量明显低于非夹闭组（A 组）（p < 0.001 和 p = 0.005，分别为术后第 1 天和第 2 天）。夹闭组（B 组）术后 12 小时血红蛋白水平下降 2.8 ± 0.9 g/dL，也低于非夹闭组（B 组）3.2 ± 0.8 g/dL。在 3 小时间隔夹闭方案中，需要输血的患者人数是不夹闭方案的 2.2 倍，但差异无统计学意义（比值比=2.20，p = 0.24），输血的显著预测因素是术前血红蛋白水平（比值比=7.73，p < 0.001）。在我们的研究中，没有发现伤口感染或临床静脉血栓栓塞事件。
3 小时间隔夹闭是一种新的减少 TKA 后失血的方案。该方案可减轻术后血红蛋白水平下降。该方案易于实施，不会增加临床血栓栓塞事件和伤口并发症。
