Manoharan Varaguna, Grant Andrea L, Harris Alicia C, Hazratwala Kaushik, Wilkinson Matthew P R, McEwen Peter J C
The Orthopaedic Research Institute of Queensland (ORIQL), Pimlico, Queensland, Australia; Mater Health Services North Queensland Ltd, Pimlico, Queensland, Australia; The Orthopaedic Department, The Townsville Hospital, Townsville, Queensland, Australia.
The Orthopaedic Research Institute of Queensland (ORIQL), Pimlico, Queensland, Australia; Mater Health Services North Queensland Ltd, Pimlico, Queensland, Australia.
J Arthroplasty. 2016 Nov;31(11):2487-2494. doi: 10.1016/j.arth.2016.04.016. Epub 2016 Apr 28.
The purpose of this study was to assess the effect of negative pressure wound therapy (NPWT) on quality of life (QoL), wound complications, and cost after primary knee arthroplasty.
A prospective analysis of 33 patients undergoing primary knee arthroplasty performed by 3 surgeons in one institution. The first 12 patients (3 bilateral and 9 unilateral) had conventional dry dressings (CDD) applied and cost of dressings was assessed. The other 21 patients all underwent bilateral knee arthroplasty and had either side randomized to receiving NPWT or CDD. Cost of dressings, wound complications, and QoL were compared.
One patient had a reaction to the NPWT requiring readmission. Another had persistent wound drainage that required NPWT application. There were no wound issues in the remaining 31 patients. The average cost in the first 12 patients was Australian dollar $48.70 with an average of 1.5 changes on ward. In the 21 patients receiving both dressings, the average cost for CDD was less (Australian dollar $43.51 vs $396.02, P ≤ .011, effect size [ES] = 1.06). When comparing QoL factors, wound leakage (0.14 vs 0.39 P = .019, ES = 1.02), and wound protection (0.16 vs 0.33, P = .001, ES = 0.021) were better in the NPWT group. There was no other significant difference in QoL factors. The average number of changes on the ward was less for the NPWT group (1.19 vs 1.38, P = .317, ES = 1.02).
We found no benefit in wound healing or cost with NPWT post knee arthroplasty. There was some benefit in NPWT QoL factors less wound leakage and better protection.
本研究旨在评估负压伤口治疗（NPWT）对初次全膝关节置换术后生活质量（QoL）、伤口并发症及费用的影响。
对一家机构中由3名外科医生实施初次全膝关节置换术的33例患者进行前瞻性分析。前12例患者（3例双侧及9例单侧）采用传统干敷料（CDD），并评估敷料费用。另外21例患者均接受双侧膝关节置换术，将每侧随机分为接受NPWT或CDD组。比较敷料费用、伤口并发症及QoL。
1例患者对NPWT有反应，需再次入院。另1例患者伤口持续引流，需应用NPWT。其余31例患者无伤口问题。前12例患者的平均费用为48.70澳元，平均在病房换药1.5次。在接受两种敷料的21例患者中，CDD的平均费用更低（43.51澳元对396.02澳元，P≤.011，效应量[ES]=1.06）。比较QoL因素时，NPWT组的伤口渗漏情况（0.14对0.39，P=.019，ES=1.02）及伤口保护情况（0.16对0.33，P=.001，ES=0.021）更好。QoL的其他因素无显著差异。NPWT组在病房的平均换药次数更少（1.19对1.38，P=.317，ES=1.02）。
我们发现全膝关节置换术后NPWT在伤口愈合或费用方面无益处。NPWT在QoL因素方面有一些益处，即伤口渗漏更少且保护更好。
