目的 比较留置皮下或关节腔内引流在人工膝关节置换术中的应用效果.方法 前瞻性地收集2013年5月至2015年5月于我院行单侧全膝关节置换术的96例病人,随机分为皮下组和关节腔组各48例,皮下组在缝合深筋膜后留置皮下引流管进行引流,而关节腔组缝合深筋膜前将引流管留置于关节腔内引流.对比两组病人术后失血情况[引流量、血红蛋白(Hb)和红细胞比容(HCT)下降程度、隐性失血量],切口相关并发症以及术后不同时间点的美国膝关节协会(the American Knee Society,AKS)关节功能评分.结果 皮下组病人的术后引流量、Hb和HCT下降程度分别为(163.45±83.53)ml、(26.34± 8.26)g/L、17.46%±5.26%,均显著低于关节腔组[(426.53±112.3)ml、(35.26±9.26)g/L、23.26%±6.34%],差异均有统计学意义(P均<0.05).两组病人在异体输血率、隐性失血量、切口相关并发症、术后膝关节功能等方面差异均无统计学意义(P均>0.05).结论 在人工膝关节置换手术中,缝合深筋膜后留置皮下引流的方式与常规关节腔内引流相比,可以显著减少术后引流量、术后Hb和HCT下降程度,而且在隐性失血量、并发症发生率以及膝关节功能恢复方面并无明显差异.%Objective To compare the applied effects of subcutaneous versus intraarticular closed suction indwelling drainage after total knee arthroplasty(TKA). Methods Ninety-six cases undergoing TKA from May 2013 to May 2015 in our hospital were included in our study prospectively.All of the patients were randomly divided into subcutaneous group (with subcutaneous indwelling) and intraarticular group (intraarticular indwelling),and 48 cases in each group.The blood loss[drainage volume,hemoglobin(Hb)and HCT decrease,transfusion requirements],incidence of wound problems and the American Knee Society(AKS) function score were compared between two groups. Results The drainage volume, Hb and HCT decrease in subcutaneous group were(163.45±83.53)ml,(26.34±8.26)g/L and 17.46%±5.26%,which were significantly lower than those in intraarticular group[(426.53 ± 112.3) ml, (35.26 ± 9.26) g/L, 23.26% ± 6.34%], and the differences were statistically significant (P<0.05 for all). There were no significant differences in hidden hemorrhage,allogenic transfusion requirements,incidence of wound problems and functional outcomes between two groups (P>0.05 for all). Conclusion Subcutaneous indwelling closed suction drainage in TKA could reduce drainage volume, Hb and HCT decrease and no differences were in hidden hemorrhage, allogenic transfusion requirements,incidence of wound problems and functional outcomes as compared with intraarticular closed suction indwelling drainage.
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