CAJ | 학술논문

目的探讨人工全膝关节置换术后不同引流方式对临床疗效的影响.方法将2010年10月至2012年11月55例接受单侧初次人工全膝关节置换患者分为三组:引流自体血回输组25例、延迟开放引流组12例、常规引流组18例.各组采用相同的手术技术和术后处理,比较术后总引流量(包括术中开放止血带止血时的出血量),异体血输血情况,术后第1、3、7天体温,手术前后血红蛋白值,肢体肿胀情况,伤口愈合质量和术后关节功能.结果引流自体血回输组平均引流量为(799.2±196.7) ml,明显多于其他两组；延迟开放引流组平均引流量为(381.7±129.2) ml,明显少于常规引流组(666.1±155.0) ml.常规引流组术后第1天血红蛋白平均为(81.33±9.86) g/L,引流自体血回输组平均为(91.96±9.57)g/L和延迟开放引流组平均为(91.50±7.92) g/L,较常规引流组明显升高,差异有统计学意义；而引流自体血回输组与常规引流组的差异无统计学意义.常规引流组有8例患者(44.4％)术后接受异体血输注,明显多于引流自体血回输组(4例,16.0％)和延迟开放引流组(2例,16.7％),差异有统计学意义；引流自体血回输组与常规引流组的差异无统计学意义.引流自体血回输组术后第1、3、7天最高体温明显增高,与其他两组的差异有统计学意义.术后肢体肿胀、伤口愈合质量和术后关节功能三组的差异无统计学意义.结论延迟开放引流可以减少术后显性失血,降低异体血输注率,与自体引流血回输相比,降低术后发热和额外费用,带来更大的临床收益,值得进一步探讨和应用.
목적 탐토인공전슬관절치환술후불동인류방식대림상료효적영향.방법 장2010년10월지2012년11월55례접수단측초차인공전슬관절치환환자분위삼조:인류자체혈회수조25례、연지개방인류조12례、상규인류조18례.각조채용상동적수술기술화술후처리,비교술후총인류량(포괄술중개방지혈대지혈시적출혈량),이체혈수혈정황,술후제1、3、7천체온,수술전후혈홍단백치,지체종창정황,상구유합질량화술후관절공능.결과 인류자체혈회수조평균인류량위(799.2±196.7) ml,명현다우기타량조；연지개방인류조평균인류량위(381.7±129.2) ml,명현소우상규인류조(666.1±155.0) ml.상규인류조술후제1천혈홍단백평균위(81.33±9.86) g/L,인류자체혈회수조평균위(91.96±9.57)g/L화연지개방인류조평균위(91.50±7.92) g/L,교상규인류조명현승고,차이유통계학의의；이인류자체혈회수조여상규인류조적차이무통계학의의.상규인류조유8례환자(44.4％)술후접수이체혈수주,명현다우인류자체혈회수조(4례,16.0％)화연지개방인류조(2례,16.7％),차이유통계학의의；인류자체혈회수조여상규인류조적차이무통계학의의.인류자체혈회수조술후제1、3、7천최고체온명현증고,여기타량조적차이유통계학의의.술후지체종창、상구유합질량화술후관절공능삼조적차이무통계학의의.결론 연지개방인류가이감소술후현성실혈,강저이체혈수주솔,여자체인류혈회수상비,강저술후발열화액외비용,대래경대적림상수익,치득진일보탐토화응용.
Objective To compare the clinical outcomes of different drains in total knee arthroplasty.Methods Fifty-five patients,who had accepted primary unilateral total knee arthroplasty from October 2010 to November 2012,were included in the comparative study.Based on different drainage ways,25 patients were arranged into autotransfusion drain group,18 into routine drain group,and 12 into delayed drain group.Same operative procedure and postoperative care were provided to all patients.The total amount of postoperative drainage (including intraoperative blood loss),information of allogenic blood transfusion,body temperatures of patients on postoperative 1st,3rd,7th day,pre-and post-operative hemoglobin level,and postoperative swelling,wound healing quality and range of motion were recorded and compared.Results The amount of drainage was significantly more in autotransfusion drain group (799.2±196.7ml)than those in other two groups (381.7±129.2 ml in delayed drain group and 666.1±155.0ml in routine drain group).The postoperative hemoglobin level in delayed drain group (91.50±7.92 g/L)was similar to that in autotransfusion group (91.96±9.57 g/L),while significantly higher than that in routine drain group (81.33±9.86 g/L).The highest body temperature of patients in autotransfusion drain group was higher than those in other two groups.Allogenic blood transfusion was performed in 8 patients (44.4％) in routine drain group,4 patients (16.0％) in autotransfusion drain group and 2 patients (16.7％) in delayed drain group.There were no differences between groups in swelling,wound healing quality,and range of motion.Conclusion Delayed release of drain in total knee arthroplasty could reduce blood loss,chances of allogenic blood transfusion and postoperative fever,and extra cost,which can bring more benefits to patients.