Yang Jae-Hyuk, Yoon Jung-Ro, Dahuja Anshul, Song Seungyeop
Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea.
Indian J Orthop. 2016 Jan-Feb;50(1):59-64. doi: 10.4103/0019-5413.173515.
Total knee arthroplasty (TKA) is widely accepted treatment for moderate or severe osteoarthritis and rheumatoid arthritis. Significant blood loss can be seen during the early postoperative period where a blood transfusion may be necessary. Closed suction drainage is known to prevent the formation of hematomas in the operative field, decrease tension on incisions, diminish delayed wound healing and reduce the risk of infection. Subcutaneous indwelling closed suction drainage method has been known to be beneficial and an alternative to the intraarticular indwelling method. This prospective randomized study was to compare the visible, hidden, total blood loss and postoperative hemodynamic change of subcutaneous and intraarticular indwelling closed suction drainage method after TKA.
One hundred and sixty patients with primary osteoarthritis who underwent unilateral TKA were enrolled; group A with subcutaneous (n = 78) and group B with intraarticular (n = 79) indwelling closed suction drainage method. Total blood loss, visible blood loss, internal blood loss, postoperative day 1, 5(th), 10(th) day hemoglobin, hematocrit levels were compared. Allogeneic blood transfusion rate and complications related to soft tissue hematoma formation were additionally compared.
Allogenic transfusion requirements between subcutaneous drainage group and intraarticular drainage groups (6.4% vs. 24.1%) were significantly different (P = 0.002). Although the minor complications such as the incidence of bullae formation and the ecchymosis were higher in the subcutaneous indwelling group, the functional outcome at postoperative 2 year did not demonstrate the difference from intraarticular drainage group.
Subcutaneous indwelling closed suction drainage method is a reasonable option after TKA for reduction of postoperative bleeding and transfusion rate.
全膝关节置换术（TKA）是治疗中度或重度骨关节炎和类风湿性关节炎的广泛接受的方法。术后早期可能会出现大量失血，此时可能需要输血。已知闭式吸引引流可防止手术区域形成血肿，减轻切口张力，减少伤口延迟愈合并降低感染风险。皮下留置闭式吸引引流方法已被认为是有益的，并且是关节内留置方法的一种替代方案。这项前瞻性随机研究旨在比较TKA术后皮下和关节内留置闭式吸引引流方法的可见、隐性、总失血量及术后血流动力学变化。
纳入160例行单侧TKA的原发性骨关节炎患者；A组采用皮下留置（n = 78），B组采用关节内留置（n = 79）闭式吸引引流方法。比较总失血量、可见失血量、内失血、术后第1天、第5天、第10天的血红蛋白、血细胞比容水平。另外比较异体输血率和与软组织血肿形成相关的并发症。
皮下引流组和关节内引流组之间的异体输血需求（6.4%对24.1%）有显著差异（P = 0.002）。虽然皮下留置组大疱形成和瘀斑的发生率等轻微并发症较高，但术后2年的功能结果与关节内引流组无差异。
皮下留置闭式吸引引流方法是TKA术后减少术后出血和输血率的合理选择。
