全髋关节置换三种引流方式比较

Comparison of three drainage methods for total hip arthroplasty

摘要:

[目的] 比较全髋关节置换（total hip arthroplasty, THA） 三种术后引流方式。[方法] 2018 年1 月—2022 年3 月150例初次单侧THA 患者按照随机数字表法分成三组，50 例行负压引流，50 例行常压引流，50 例行正压引流。比较三组早期临床及检验结果。[结果] 三组患者手术均顺利完成，三组手术时间、切口总长度及术中失血量的差异均无统计学意义（P＞0.05）。术后总引流量[(335.9±38.1) ml vs (269.7±39.6) ml vs (187.0±34.8) ml, P＜0.001]、总失血量[(801.7±57.2) ml vs (720.9±58.6) ml vs(618.1±53.4) ml, P＜0.001] 及隐性失血量[(284.1±40.9) ml vs (263.7±37.8) ml vs (246.6±36.0) ml, P＜0.001] 均由大至小依次为负压组＞ 常压组＞ 正压组。相应时间点三组间切口痛VAS 评分和髋围比较差异均无统计学意义（P＞0.05）。检验方面，与术前相比术后2 d 三组患者Hb、Hct、RBC 水平均显著降低（P＜0.05）。术后2 d Hb [(90.6±10.3) g/L vs (94.3±9.2) g/L vs (98.1±8.9) g/L, P＜0.001]、Hct [(27.0±0.0)% vs (30.0±0.0)% vs (33.8±0.1)%, P＜0.001]、RBC [(3.3±0.3)×1012/L vs (3.5±0.3)×1012/L vs (3.7±0.3)×1012/L, P＜0.001] 均由小至大依次为负压组＜ 常压组＜ 正压组。三组患者术后输血率及切口愈合等级的差异均无统计学意义（P＞0.05）。[结论] THA 术后采用早期夹闭4 h 联合引流管中段抬高正压引流可有效减少术后失血量，且不增加切口痛及髋部肿胀，是一种简单有效可供临床选择的引流方式。

Abstract:

[Objective] To compare three postoperative drainage methods for total hip arthroplasty (THA). [Methods] From January2018 to March 2022, 150 patients who were undergoing primary unilateral THA were divided into three groups according to random num-ber table method, 50 patients had negative pressure drainage, 50 patients underwent normal pressure drainage, and 50 patients receivedpositive pressure drainage. The early clinical and blood test documents of the three groups were compared. [Results] All patients in the 3groups had THA performed successfully, with no significant differences in operation time, total incision length and intraoperative blood lossamong the three groups (P＞0.05). The postoperative total drainage volume [(335.9±38.1) ml vs (269.7±39.6) ml vs (187.0±34.8) ml, P＜0.001], total blood loss [(801.7±57.2) ml vs (720.9±58.6) ml vs (618.1±53.4) ml, P＜0.001] and latent blood loss [(284.1±40.9) ml vs (263.7±37.8) ml vs (246.6±36.0) ml, P＜0.001] were all ranked up-down as the negative pressure group ＞ the normal pressure group ＞ the positivepressure group. There were no significant differences in incision pain VAS score and hip circumference among the three groups at any corre-sponding time points (P＞0.05). In terms of blood test, Hb, Hct and RBC levels were significantly decreased in all the three groups 2 days af-ter surgery compared with those before surgery (P＜0.05). Two days postoperatively the Hb [(90.6±10.3) g/L vs (94.3±9.2) g/L vs (98.1±8.9 g/L, P＜0.001], Hct [(27.0±0.0)% vs (30.0±0.0)% vs (33.8±0.1)%, P＜0.001], RBC [(3.3±0.3)×1012/L vs (3.5±0.3)×1012/L vs (3.7 ±0.3)×1012/L,P＜0.001] were all ranked down-up as the negative pressure group ＜ the normal pressure group ＜ the positive pressure group. However,there were no significant differences in postoperative blood transfusion rate and incision healing grade among the three groups (P＞0.05).[Conclusion] The combination of early clamping for 4 hours and positive pressure drainage after THA can effectively reduce the postopera-tive blood loss without increasing the incision pain and hip swelling, which is a simple and effective drainage method for clinical selection.