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血友病性关节病患者行全膝关节置换术时负压引流效果的评估

Evaluation of outcomes of suction drainage in patients with haemophilic arthropathy undergoing total knee arthroplasty.

作者信息

Mortazavi S M J, Firoozabadi M A, Najafi A, Mansouri P

机构信息

Joint reconstruction research center, Imam Khomeini hospital, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Haemophilia. 2017 Jul;23(4):e310-e315. doi: 10.1111/hae.13224. Epub 2017 May 24.

Abstract

INTRODUCTION

Closed suction drainage has been extensively applied for orthopaedic procedures for the sake of avoiding fluid collections around the wound at the operated limb.

AIM

We believed that without application of suction drainage after total knee arthroplasty (TKA), the risk of infection and haematoma formation will not increase while the need for blood transfusion because of decreased blood loss will be lesser.

METHODS

In a prospective randomized clinical trial from April 2010 to April 2014, 176 patients with haemophilia who underwent TKA were included. The study group consisted of 88 patients (108 knees), in which we did not insert suction drain and the control group included 88 patients (106 knees), in which drain was inserted at the end of the surgery. All patients underwent TKA via anterior knee incision and medial parapatellar approach.

RESULTS

The mean follow-up period of study group and control group was 21 ± 11 months vs. 20 ± 9 months consecutively (P = 0.54). The mean hospital stay was 13 ± 8 days vs. 14 ± 8 days in study and control group consecutively (P = 0.40). In both groups, the major part of improvement in clinical knee society score was due to increase in pain subset (mean increase of 42 vs. 39 points consecutively) and to a lesser extent to alleviation of flexion contracture (mean increase of 13 vs. 15 points consecutively). We observed no differences in the mean visual analogue scale (VAS) value between both groups. Average functional outcome in both groups improved during follow-up visits.

CONCLUSION

We can conclude that there is no rationale for the use of drain after primary TKA.

摘要

引言

闭式吸引引流已广泛应用于骨科手术,以避免手术肢体伤口周围出现积液。

目的

我们认为,全膝关节置换术(TKA)后不应用吸引引流,感染和血肿形成的风险不会增加,同时因失血减少而需要输血的情况也会减少。

方法

在2010年4月至2014年4月进行的一项前瞻性随机临床试验中,纳入了176例行TKA的血友病患者。研究组由88例患者(108膝)组成,其中我们未插入吸引引流管;对照组包括88例患者(106膝),在手术结束时插入引流管。所有患者均通过膝关节前切口和髌旁内侧入路进行TKA。

结果

研究组和对照组的平均随访期分别为21±11个月和20±9个月(P = 0.54)。研究组和对照组的平均住院时间分别为13±8天和14±8天(P = 0.40)。在两组中,膝关节协会临床评分改善的主要部分归因于疼痛亚组的增加(平均分别增加42分和39分),在较小程度上归因于屈曲挛缩的减轻(平均分别增加13分和15分)。我们观察到两组之间的平均视觉模拟量表(VAS)值没有差异。两组的平均功能结果在随访期间均有所改善。

结论

我们可以得出结论,初次TKA后使用引流管没有依据。

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