【摘要】 背景:全膝关节置换术(TKA)后夹闭引流管可减少术后失血,但夹闭时间过长可造成关节腔内血肿、关节肿胀及疼痛,影响关节活动。目的:通过比较TKA术后不同引流管夹闭时间对手术失血量、疼痛和关节功能恢复的影响,探究最适夹闭时间。方法:选取拟行单侧TKA的患者共150例,随机分为不夹管、夹管1、2、3、4 h组5组,每组各30例。记录各组患者术前、术后引流量、总失血量、肢体周径变化、疼痛视觉模拟评分(VAS)、膝关节活动度(ROM)和膝关节评分(HSS),并进行比较。结果:夹管时间越长,引流量越少,组间两两比较差异均有统计学意义(P均<0.05)。夹管4 h组与夹管3 h组患者比较总失血量差异无统计学意义,但肢体周径变化更大,且差异有统计学意义(P<0.05)。与不夹管组、夹管1 h组患者比较,术后1、3 d夹管4 h组患者术后疼痛VAS评分均增加,术后3 d ROM减小,且差异均有统计学意义(P均<0.05)。术后2周、3个月各组患者HSS评分差异均无统计学意义(P均>0.05)。结论:夹管3 h是一个相对合理的时间,既可以减少术后失血量,不明显增加术后疼痛,也不会影响关节功能的恢复。更多还原

【Abstract】 Background: Clamping drainage tube is an effective method to reduce blood loss after total knee arthroplasty(TKA). However, overtime clamping will result in hematoma in the articular cavity and joint swelling and pain, even affect joint activities. Objective: To investigate the optimal clamping time by comparing the influence of different clamping time of drainage tube on postoperative blood loss, pain and joint function recovery. Methods: A total of 150 patients undergoing unilateral TKA were divided into five groups(n=30): non-clamping group, 1 h-clamping group, 2 h-clamping group, 3 h-clamping group, and 4 h-clamping group. Drainage volume, total blood loss, lower limb swelling, VAS score, range of motion(ROM) and HSS score were recorded. Results: The longer the clamping time was, the less the drainage volume was(P<0.05). There was no statistical difference in the total blood loss between 4 h-clamping group and 3 h-clamping group, but the change of lower limb swelling in 4 h-clamping group was more obvious than that in 3 h-clamping group(P<0.05). 4 h-clamping resulted in the increase of pain score(postoperative 1 d and 3 d) and affected ROM on day 3 postoperatively compared with no clamping and 1 h-clamping(P<0.05). There was no statistical difference in the HSS score at 2 weeks or 3 months postoperatively among different groups(P>0.05). Conclusions: Three-hour is a relatively appropriate clamping time, which can reduce postoperative blood loss, will not significantly increase the pain or affect knee function recovery.更多还原