【摘要】：目的：根據(jù)初次單側(cè)人工全膝關(guān)節(jié)表明置換術(shù)后臨時(shí)夾閉引流管不同時(shí)間點(diǎn)對(duì)失血量及膝關(guān)節(jié)功能的影響,初步探討引流管夾閉的時(shí)機(jī)。方法：本研究采用前瞻性隨機(jī)對(duì)照研究的方法,選取2014年5月至2015年12月于莆田學(xué)院附屬醫(yī)院骨科行初次單側(cè)人工全膝關(guān)節(jié)表面置換手術(shù)病例,術(shù)后于不同時(shí)間點(diǎn)夾閉引流管,病例隨機(jī)分為4組：未夾閉組、夾閉2小時(shí)組、夾閉4小時(shí)組及夾閉6小時(shí)組。對(duì)比分析各組患者術(shù)后總失血量、術(shù)后24小時(shí)引流量、血紅蛋白丟失量、輸血人數(shù)、肢體周徑的變化、術(shù)后第3、6天膝關(guān)節(jié)活動(dòng)度、術(shù)后第1、3、5天VAS評(píng)分、術(shù)后2周、3個(gè)月HSS膝關(guān)節(jié)評(píng)分、瘀斑及并發(fā)癥。結(jié)果：共80例患者進(jìn)入最終統(tǒng)計(jì),其中男性9例,女性71例。各組患者在性別、年齡、身高、體重均無(wú)統(tǒng)計(jì)學(xué)差異。未夾閉組總失血量(1687.29±162.74)ml,大于夾閉2小時(shí)組(1332.52±86.68)ml、夾閉4小時(shí)組(1049.92±69.44)ml和夾閉6小時(shí)組(826.98±50.55)ml,各組間差異存在統(tǒng)計(jì)學(xué)意義。未夾閉組術(shù)后24小時(shí)引流量(558.65±35.46)ml,大于夾閉2小時(shí)組(460.20±38.00)ml、夾閉4小時(shí)組(342.50±25.39)ml和夾閉6小時(shí)組(269.45±33.01)ml,各組間差異存在統(tǒng)計(jì)學(xué)意義。血紅蛋白丟失量方面,未夾閉組(229.63±30.08)g大于夾閉2小時(shí)組(177.57±18.14)g、夾閉4小時(shí)組(137.74±14.92)g和夾閉6小時(shí)組(104.84±7.42)g,各組間差異存在統(tǒng)計(jì)學(xué)意義。四組輸血患者比例分別為35%(7/20)、5%(1/20)、0%(0/20)、0%(0/20),夾閉組均低于未夾閉組。各組術(shù)后周徑變化比較中,夾閉6小時(shí)組變化大于夾閉4小時(shí)組、夾閉2小時(shí)組及未夾閉組,差異存在統(tǒng)計(jì)學(xué)意義。夾閉4小時(shí)組變化大于夾閉2小時(shí)組及未夾閉組,差異存在統(tǒng)計(jì)學(xué)意義。夾閉2小時(shí)組與未夾閉組差異無(wú)統(tǒng)計(jì)學(xué)意義。術(shù)后第3天膝關(guān)節(jié)活動(dòng)度上,夾閉6小時(shí)組低于其他三組,差異有統(tǒng)計(jì)學(xué)意義,而未夾閉組、夾閉2小時(shí)組及夾閉4小時(shí)組之間差異無(wú)統(tǒng)計(jì)學(xué)異常。四組術(shù)后第6天膝關(guān)節(jié)活動(dòng)度的比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。各組術(shù)前、術(shù)后2周、3個(gè)月HSS評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義。術(shù)后第1、3天VAS評(píng)分中,夾閉6小時(shí)組高于其他三組,差異存在統(tǒng)計(jì)學(xué)意義(P0.05),夾閉4小時(shí)組、夾閉2小時(shí)組及未夾閉組差異無(wú)統(tǒng)計(jì)學(xué)意義。術(shù)后第5天,各組間的VAS評(píng)分差異不存在統(tǒng)計(jì)學(xué)意義(P0.05)。各組在術(shù)后瘀斑及并發(fā)癥方面比較差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論：TKA術(shù)后引流管夾閉4小時(shí)是一個(gè)比較合適的夾閉時(shí)間點(diǎn),既能減少術(shù)后引流量及失血量,降低輸血率,又不增加術(shù)后短時(shí)間疼痛,且不影響膝關(guān)節(jié)活動(dòng)及功能。
[Abstract]:Objective: to investigate the effect of temporary clipping of drainage tube on blood loss and knee joint function after primary unilateral total knee arthroplasty. Methods: a prospective randomized controlled study was conducted in the orthopedic department of Putian University affiliated Hospital from May 2014 to December 2015. The first total knee arthroplasty was performed and the drainage tube was clamped at different time points after operation. The patients were randomly divided into 4 groups: no clamping group, 2 hour clipping group, 4 hour clipping group and 6 hour clipping group. The changes of total blood loss, 24 hour drainage, hemoglobin loss, blood transfusion, limb circumference, knee joint motion on the 3rd day, and VAS score on the 1st day and 3th day after operation were compared and analyzed. HSS knee joint score, ecchymosis and complications 2 weeks and 3 months after operation. Results: a total of 80 patients entered the final statistics, including 9 males and 71 females. There was no significant difference in sex, age, height and weight. The total blood loss in the unclipped group (1687.29 鹵162.74) ml, was significantly higher than that in the 2-hour clipping group (1332.52 鹵86.68) ml, clipping for 4 hours (1049.92 鹵69.44) ml and the clipping 6 hour group (826.98 鹵50.55) ml,. The drainage flow (558.65 鹵35.46) ml, in the non-clipping group was significantly higher than that in the 2-hour clipping group (460.20 鹵38.00) ml, clipping for 4 hours (342.50 鹵25.39) ml and the clipping 6 hours group (269.45 鹵33.01) ml,. The hemoglobin loss in the unclamped group (229.63 鹵30.08) g was significantly higher than that in the 2-hour clipping group (177.57 鹵18.14) g, in the 4-hour clipping group (137.74 鹵14.92) g and in the clipping 6-hour group (104.84 鹵7.42) g. The four groups were 35% (7 / 20), 5% (1 / 20), 0% (0 / 20), 0% (0 / 20), respectively. The change of circumference in 6 hours clipping group was greater than that in 4 hour clipping group, 2 hour clipping group and no clipping group, the difference was statistically significant. The changes of 4 hour clipping group were greater than that of 2 hour clipping group and non-clipping group, and the difference was statistically significant. There was no significant difference between the 2 hour clipping group and the non-clamped group. On the 3rd day after operation, the degree of knee joint motion in the 6 hour clipping group was lower than that in the other three groups, the difference was statistically significant, but there was no significant difference between the non clipping group, the 2 hour clipping group and the 4 hour clipping group. There was no significant difference in knee motion between the four groups on the 6th day after operation (P0.05). There was no significant difference in HSS score before operation, 2 weeks and 3 months after operation. The VAS score of the 6-hour clipping group was significantly higher than that of the other three groups on the 1st and 3rd day after operation (P0.05). There was no significant difference between the 4-hour clipping group, the 2-hour clipping group and the non-clipping group. On the 5th day after operation, there was no significant difference in VAS score among the groups (P0.05). There was no significant difference in postoperative ecchymosis and complications among the groups. Conclusion: the clamping of drainage tube for 4 hours after TKA is a suitable clipping time point. It can not only reduce postoperative drainage flow and blood loss, reduce blood transfusion rate, but also do not increase postoperative pain, and does not affect knee joint movement and function.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R687.4

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