最佳手术引流管固定管理：尸体研究。
Optimal Management of Tethered Surgical Drains: A Cadaver Study.
机构信息
From Norton Leatherman Spine Center, University of Louisville Medical Center, Louisville, KY (Dr. Laratta, Dr. Shillingford), the Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital at New York-Presbyterian (Dr. Lombardi, Dr. Lenke, Dr. Riew, Dr. Lehman), and Department of Orthopaedic Surgery New York-Presbyterian/Columbia University Medical Center, New York, NY (Dr. Grosso, Dr. Levine).
出版信息
J Am Acad Orthop Surg. 2019 Feb 15;27(4):129-135. doi: 10.5435/JAAOS-D-17-00122.
BACKGROUND
Tethered drains are a complication of drain usage and may result in unintentional retained broken drains, as well as anxiety and uncertainty for the surgeon and the patient. To date, no study has examined the optimal approach for management and removal of tethered drains.
METHODS
The study design sought to identify suture size, mechanism of drain fixation (through versus around), points of constriction (one versus multiple) and the efficacy of weighted traction as potential sources of tethered drains by means of four study arms. (1) Arm one compared drains sutured through the tubing versus a tight closure of the surrounding fascia, which were then subjected to weighted suspension. (2) Arm two compared drains sutured into the fascia using eight each of 4-0, 2-0 and 0 vicryl and then subject to manual traction. (3) Arm three compared drains sutured to the fascia through the tubing versus local tissue incarceration followed by manual traction. (4) Lastly, group four examined drains tethered at two distinct points after which they were subject to manual traction.
RESULTS
Our results showed a 25% drain retention rate when manual traction was applied to 0 vicryl and 2-0 vicryl suture. In contrast, there were no instances of drain retention when suture was closed with 4-0 vicryl. When evaluating for multiple points of fixation, drains tethered in two locations were retained in 87.5% of trials versus drains with a single tether point (25%) representing a statistical significance (P = 0.041). There was no difference in rates of drain retention when pierced through the tubing versus incarcerated in local fascia. Only one of the 16 drains was successfully removed by weighted suspension (8.3%). Attempts at manual traction following weighted suspension resulted in a 50% drain retention rate which was higher than the rates of immediate manual traction (18.8%).
CONCLUSION
Our results found that manual traction is a reasonable first line approach to address drains tethered by all methods and suture sizes. The use of weighted traction for the management of tethered drains is less effective than manual traction and may result in more retained drain fragments.
LEVEL OF EVIDENCE
Level IV.
背景
引流管的固定缝线是引流管使用的并发症之一，可能导致引流管的意外残留和断裂，同时也会给外科医生和患者带来焦虑和不确定性。迄今为止，尚无研究探讨处理和移除固定缝线的最佳方法。
方法
本研究设计旨在通过四个研究臂来确定缝线的大小、引流管固定机制（穿过还是绕过）、缝线的收紧部位（一个还是多个）以及重物牵引的效果，这些因素都可能是导致引流管固定的原因。（1）第 1 组臂将引流管穿过引流管与周围筋膜紧密缝合，然后进行重物悬吊。（2）第 2 组臂将 4-0、2-0 和 0 薇乔缝线各 8 根穿过筋膜进行缝合，然后进行手动牵引。（3）第 3 组臂将引流管穿过引流管与局部组织嵌顿缝合，然后进行手动牵引。（4）最后，第 4 组臂检查在两个不同部位固定的引流管，然后进行手动牵引。
结果
我们的结果显示，当对 0 薇乔缝线和 2-0 薇乔缝线进行手动牵引时，引流管的保留率为 25%。相比之下，当使用 4-0 薇乔缝线缝合时，引流管没有保留。在评估多个固定点时，在两个部位固定的引流管中有 87.5%的试验出现引流管保留，而在一个部位固定的引流管中有 25%的试验出现引流管保留，这具有统计学意义（P=0.041）。引流管穿过引流管与嵌顿在局部筋膜中的保留率无差异。在 16 个引流管中，只有 1 个（8.3%）成功通过重物悬吊移除。在进行重物悬吊后进行手动牵引，引流管的保留率为 50%，高于立即进行手动牵引的保留率（18.8%）。
结论
我们的研究结果发现，手动牵引是处理所有方法和缝线大小固定的引流管的合理一线方法。使用重物牵引处理固定缝线的效果不如手动牵引，可能导致更多的引流管残留。
证据等级
4 级。
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