全髋关节置换术（THA）后伤口是否放置引流管的临床对比研究

发布时间：2018-04-04 09:52

本文选题：全髋关节置换术　切入点：引流　出处：《华北理工大学》2017年硕士论文

【摘要】：目的人工全髋关节置换术(THA)在临床应用越来越普遍,已经成为治疗终末期髋关节疾患的首要选择[1]。为了减少积液、预防血肿及感染发生,引流管系统被广泛应用于全髋关节置换术后。本研究通过对比初次全髋关节置换术后引流管在减少术后并发症、提高患者健康质量方面的实际临床效果,进而探讨引流管系统在全髋关节置换术后存在的合理性与安全性,为术后伤口的妥善处理提供合理建议。方法筛选符合试验方案的唐山二院关节二科2014年4月至2015年12月初次单侧全髋关节置换术病例共52髋,按随机分组原则分为引流组和非引流组各26例。系统观察比较三大项目指标:1包括手术前后血红蛋白、围手术期总失血量、血清蛋白、红细胞比积下降值等客观检验内容;2并发症指征如伤口渗液、血肿、感染、双下肢深静脉血栓等临床指标;3其他指标包括输血例数、住院花销(去除假体费用)、术后48h情绪评分(汉密尔顿焦虑量表即HAMA)、出院后随访第3、6、12个月髋关节Charnley评分等,进行统计学分析有无统计学意义,客观评估全髋关节置换术后伤口内置引流管的实际临床效果和安全性。结果1通过比较发现引流组血清蛋白、红细胞比积术后下降值及输血例数均明显高于非引流组,引流组并发症总体发生率高于非引流组,非引流组患者的住院花销少于引流组,组内比较两组患者术后1年髋关节Charnley评分较出院3个月时提升幅度较大,引流组情绪焦虑评分较术前增长值明显高于非引流组,这些指标均具有统计学意义(P0.05)。2全髋关节置换术后可能与伤口放置引流管有关的并发症如伤口渗液、血肿、感染及双下肢深静脉血栓等发生率的统计,引流组个别指标偏高,但组间差异不明显。引流组和非引流组在总失血量及48h术后血红蛋白比较无特质性差异,术后三次随访(3、6、12月)进行的两组间Charnley评分差异不显著,无统计意义(P0.05)。结论初次全髋关节置换术后伤口内置引流管不能减少术后并发症,相反会增加出血倾向、输血率及住院总花销,诱发患者负面情绪的产生;引流管的放置也不会明显促进患者的康复练习及髋关节功能恢复;初次全髋关节置换术后伤口内置引流管意义不大,伤口需要进一步妥善处理。
[Abstract]:The purpose of total hip arthroplasty (THA) in clinical application is more and more common, has become the first choice for treatment of [1]. in end-stage hip disease, in order to reduce the effusion, hematoma and infection prevention, drainage system is widely used in total hip arthroplasty. The study by comparing the primary total hip arthroplasty postoperative drainage tube complications in reducing postoperative actual clinical effect to improve the health quality of the patients, and to explore the feasibility and safety of existing in the total hip arthroplasty postoperative drainage tube system, provide reasonable suggestions for proper treatment of postoperative wound. Methods of screening the second hospital of Tangshan from April 2014 to December 2015 two joint primary unilateral total hip arthroplasty with the test cases for a total of 52 hips were randomly divided into drainage group and non drainage group with 26 cases in each group. To observe and compare the three item index system including surgery: 1 Before and after the hemoglobin, total perioperative blood loss, serum protein, red blood cells decreased value of objective test content than the product; 2 complications indications such as wound exudate, hematoma, infection, lower extremity deep vein thrombosis and other clinical indicators; 3 other indicators include the number of blood transfusion, hospitalization expenses (removal expenses, postoperative prosthesis) 48h scores (Hamilton anxiety scale, HAMA) after discharge in 3,6,12 months follow-up Charnley hip score, were analyzed statistically, wound drainage actual clinical efficacy and safety of the objective evaluation after total hip replacement. The 1 is found by comparing the drainage group serum protein, red blood cell decline in value and the number of blood transfusion were significantly higher than in non drainage group than the product after the operation, complications of overall drainage group incidence was higher than that of non drainage group and non drainage group hospitalization costs less than the drainage group, compared two groups of patients 1 years after the Charnley hip score was discharged 3 months to improve greatly, the drainage group anxiety score was significantly higher than the growth in non drainage group, these indexes were statistically significant (P0.05.2) after total hip arthroplasty and wound drainage related complications such as wound exudate, hematoma. Statistics and double infection of lower extremity deep venous thrombosis incidence, drainage group, individual index is high, but no significant difference between the groups. The drainage group and non drainage group in total blood loss and postoperative hemoglobin 48h no trait differences, after three times of follow-up (3,6,12 months) between the two groups of Charnley score difference no significant, no statistical significance (P0.05). Conclusion in the wound after total hip arthroplasty can reduce the postoperative complications of the drainage tube, instead of increased bleeding tendency, blood transfusion rate and total hospitalization expenses, patients induced negative emotions; The placement of drainage tube will not significantly promote the rehabilitation exercises and hip function recovery of patients. After initial total hip arthroplasty, the wound drainage tube is of little significance, and the wound needs further treatment.

【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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