初次单侧人工全膝关节表面置换术后临时夹闭引流管时间的临床研究

发布时间：2018-10-17 18:40

【摘要】：目的：根据初次单侧人工全膝关节表明置换术后临时夹闭引流管不同时间点对失血量及膝关节功能的影响,初步探讨引流管夹闭的时机。方法：本研究采用前瞻性随机对照研究的方法,选取2014年5月至2015年12月于莆田学院附属医院骨科行初次单侧人工全膝关节表面置换手术病例,术后于不同时间点夹闭引流管,病例随机分为4组：未夹闭组、夹闭2小时组、夹闭4小时组及夹闭6小时组。对比分析各组患者术后总失血量、术后24小时引流量、血红蛋白丢失量、输血人数、肢体周径的变化、术后第3、6天膝关节活动度、术后第1、3、5天VAS评分、术后2周、3个月HSS膝关节评分、瘀斑及并发症。结果：共80例患者进入最终统计,其中男性9例,女性71例。各组患者在性别、年龄、身高、体重均无统计学差异。未夹闭组总失血量(1687.29±162.74)ml,大于夹闭2小时组(1332.52±86.68)ml、夹闭4小时组(1049.92±69.44)ml和夹闭6小时组(826.98±50.55)ml,各组间差异存在统计学意义。未夹闭组术后24小时引流量(558.65±35.46)ml,大于夹闭2小时组(460.20±38.00)ml、夹闭4小时组(342.50±25.39)ml和夹闭6小时组(269.45±33.01)ml,各组间差异存在统计学意义。血红蛋白丢失量方面,未夹闭组(229.63±30.08)g大于夹闭2小时组(177.57±18.14)g、夹闭4小时组(137.74±14.92)g和夹闭6小时组(104.84±7.42)g,各组间差异存在统计学意义。四组输血患者比例分别为35%(7/20)、5%(1/20)、0%(0/20)、0%(0/20),夹闭组均低于未夹闭组。各组术后周径变化比较中,夹闭6小时组变化大于夹闭4小时组、夹闭2小时组及未夹闭组,差异存在统计学意义。夹闭4小时组变化大于夹闭2小时组及未夹闭组,差异存在统计学意义。夹闭2小时组与未夹闭组差异无统计学意义。术后第3天膝关节活动度上,夹闭6小时组低于其他三组,差异有统计学意义,而未夹闭组、夹闭2小时组及夹闭4小时组之间差异无统计学异常。四组术后第6天膝关节活动度的比较差异无统计学意义(P0.05)。各组术前、术后2周、3个月HSS评分差异无统计学意义。术后第1、3天VAS评分中,夹闭6小时组高于其他三组,差异存在统计学意义(P0.05),夹闭4小时组、夹闭2小时组及未夹闭组差异无统计学意义。术后第5天,各组间的VAS评分差异不存在统计学意义(P0.05)。各组在术后瘀斑及并发症方面比较差异无统计学意义。结论：TKA术后引流管夹闭4小时是一个比较合适的夹闭时间点,既能减少术后引流量及失血量,降低输血率,又不增加术后短时间疼痛,且不影响膝关节活动及功能。
[Abstract]:Objective: to investigate the effect of temporary clipping of drainage tube on blood loss and knee joint function after primary unilateral total knee arthroplasty. Methods: a prospective randomized controlled study was conducted in the orthopedic department of Putian University affiliated Hospital from May 2014 to December 2015. The first total knee arthroplasty was performed and the drainage tube was clamped at different time points after operation. The patients were randomly divided into 4 groups: no clamping group, 2 hour clipping group, 4 hour clipping group and 6 hour clipping group. The changes of total blood loss, 24 hour drainage, hemoglobin loss, blood transfusion, limb circumference, knee joint motion on the 3rd day, and VAS score on the 1st day and 3th day after operation were compared and analyzed. HSS knee joint score, ecchymosis and complications 2 weeks and 3 months after operation. Results: a total of 80 patients entered the final statistics, including 9 males and 71 females. There was no significant difference in sex, age, height and weight. The total blood loss in the unclipped group (1687.29 卤162.74) ml, was significantly higher than that in the 2-hour clipping group (1332.52 卤86.68) ml, clipping for 4 hours (1049.92 卤69.44) ml and the clipping 6 hour group (826.98 卤50.55) ml,. The drainage flow (558.65 卤35.46) ml, in the non-clipping group was significantly higher than that in the 2-hour clipping group (460.20 卤38.00) ml, clipping for 4 hours (342.50 卤25.39) ml and the clipping 6 hours group (269.45 卤33.01) ml,. The hemoglobin loss in the unclamped group (229.63 卤30.08) g was significantly higher than that in the 2-hour clipping group (177.57 卤18.14) g, in the 4-hour clipping group (137.74 卤14.92) g and in the clipping 6-hour group (104.84 卤7.42) g. The four groups were 35% (7 / 20), 5% (1 / 20), 0% (0 / 20), 0% (0 / 20), respectively. The change of circumference in 6 hours clipping group was greater than that in 4 hour clipping group, 2 hour clipping group and no clipping group, the difference was statistically significant. The changes of 4 hour clipping group were greater than that of 2 hour clipping group and non-clipping group, and the difference was statistically significant. There was no significant difference between the 2 hour clipping group and the non-clamped group. On the 3rd day after operation, the degree of knee joint motion in the 6 hour clipping group was lower than that in the other three groups, the difference was statistically significant, but there was no significant difference between the non clipping group, the 2 hour clipping group and the 4 hour clipping group. There was no significant difference in knee motion between the four groups on the 6th day after operation (P0.05). There was no significant difference in HSS score before operation, 2 weeks and 3 months after operation. The VAS score of the 6-hour clipping group was significantly higher than that of the other three groups on the 1st and 3rd day after operation (P0.05). There was no significant difference between the 4-hour clipping group, the 2-hour clipping group and the non-clipping group. On the 5th day after operation, there was no significant difference in VAS score among the groups (P0.05). There was no significant difference in postoperative ecchymosis and complications among the groups. Conclusion: the clamping of drainage tube for 4 hours after TKA is a suitable clipping time point. It can not only reduce postoperative drainage flow and blood loss, reduce blood transfusion rate, but also do not increase postoperative pain, and does not affect knee joint movement and function.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.4

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