CAJ | 학술논문

目的：研究人工膝关节置换术后留置皮下或关节腔内引流对临床疗效的影响。方法2011年10月至2012年9月，把本组接受单侧初次人工全膝关节置换（ TKA）手术的32例患者随机分为两组：A组（留置皮下引流组）16例，在缝合深筋膜后皮下留置引流管，接真空负压瓶引流；B组（留置关节腔内引流组）16例，在缝合前将引流管留置在关节腔内，接真空负压瓶，夹闭3 h后开放引流。各组采用相同的手术技术和术后处理，观察记录术后失血情况（引流量、血红蛋白值下降值、需要输血情况等）、局部伤口问题（伤口渗血、皮下瘀斑、肢体肿胀、伤口愈合不良、感染等）和术后关节功能（KSS）评分。结果 A组平均24 h内引流量为（142．5±140．3） ml，明显少于B组（421．2±231．7）ml （t＝4．116，P＜0．05）。 A组术后第2天血红蛋白下降量为（31．2±12．1）g／L，B组为（32．1±14．7）g／L，差异无统计学意义（t＝0．189，P＞0．05）。 A组有1例患者（6．25％）术后接受异体血输注，明显少于B组（7例，43．75％），差异有统计学意义（χ2＝4．167，P＜0．05）。术后局部伤口问题出现的例数相同。术后关节功能的差异无统计学意义（ t＝1．803，P＞0．05）。结论在缝合深筋膜后皮下留置引流管，接真空负压引流的方法可以减少术后显性失血，降低异体血输注率，与常规将引流管留置在关节腔内，接真空负压引流方法比较，带来更大的临床收益，值得进一步探讨和应用。
목적：연구인공슬관절치환술후류치피하혹관절강내인류대림상료효적영향。방법2011년10월지2012년9월，파본조접수단측초차인공전슬관절치환（ TKA）수술적32례환자수궤분위량조：A조（류치피하인류조）16례，재봉합심근막후피하류치인류관，접진공부압병인류；B조（류치관절강내인류조）16례，재봉합전장인류관류치재관절강내，접진공부압병，협폐3 h후개방인류。각조채용상동적수술기술화술후처리，관찰기록술후실혈정황（인류량、혈홍단백치하강치、수요수혈정황등）、국부상구문제（상구삼혈、피하어반、지체종창、상구유합불량、감염등）화술후관절공능（KSS）평분。결과 A조평균24 h내인류량위（142．5±140．3） ml，명현소우B조（421．2±231．7）ml （t＝4．116，P＜0．05）。 A조술후제2천혈홍단백하강량위（31．2±12．1）g／L，B조위（32．1±14．7）g／L，차이무통계학의의（t＝0．189，P＞0．05）。 A조유1례환자（6．25％）술후접수이체혈수주，명현소우B조（7례，43．75％），차이유통계학의의（χ2＝4．167，P＜0．05）。술후국부상구문제출현적례수상동。술후관절공능적차이무통계학의의（ t＝1．803，P＞0．05）。결론재봉합심근막후피하류치인류관，접진공부압인류적방법가이감소술후현성실혈，강저이체혈수주솔，여상규장인류관류치재관절강내，접진공부압인류방법비교，대래경대적림상수익，치득진일보탐토화응용。
Objective To compare the clinical outcomes of different drains in total knee arthroplasty .Methods Thirty-two patients , who had undergone TKA from October 2011 to September 2012, were included in the comparative study .The same operative procedure and postoperative care were provided to all the patients .The patients were randomized to have either a subcutaneous indwelling or an intra-articular indwelling catheter and two months after surgery , the two groups were compared for blood loss ( hemoglobin decrease , transfusion requirements , hypotension episode ) , incidence of wound problems (requirements for dressing reinforcement , oozing, hematoma, hemarthrosis, ecchymosis, infection), and functional outcomes ( value score , American Knee Society ) .Results The mean vacuum drainage volume was less in the subcutaneous indwelling group [(142.5 ±140.3) ml] than in the intra-articular indwelling group [(421.2 ±231.7) ml] (t=4.116, P<0.05).There were differences between the two groups in allogenic transfusion requirements ( 6.25% versus 43.75%, χ2 =4.167, P <0.05 ) .There was no difference between the two groups in HB decrease , incidence of wound problems and functional scores . Conclusion Subcutaneous indwelling closed suction drainage in total knee arthroplasty could reduce blood loss and chances of allogenic blood transfusion .It is a reasonable alternative to intra-articular indwelling closed-suction drainage .