Page 117 - 南京医科大学自然版

第44卷第6期 南京医科大学学报（自然科学版）
2024年6月 Journal of Nanjing Medical University（Natural Sciences） ·853 ·

·临床研究·

术中放置引流对全膝关节置换术后疗效的影响

谈正岗，王锦文，周 皓，杨 辉，黄 易，刘 锋 *
南京医科大学第一附属医院骨科，江苏 南京 210029

［摘 要］ 目的：探究全膝关节置换术（total knee arthroplasty，TKA）术中放置关节腔引流对术后失血以及关节功能恢复的影
响。方法：回顾性分析2021年9月—2022年10月在南京医科大学第一附属医院行TKA治疗的终末期膝关节骨性关节炎患者，
根据术中是否放置引流分为引流组与非引流组。对比两组患者术后失血情况、膝关节功能恢复指标、术后并发症及随访结
果。结果：共纳入患者 147 例，非引流组 53 例，引流组 94 例。与非引流组比较，引流组隐性失血（hidden blood loss，HBL）少
［（906.94±438.41）mL vs.（1 262.85±563.46）mL，P < 0.001］，但输血率、总失血量差异无统计学意义（P > 0.05）。非引流组术
后 1 d，3 d，5 d 下肢肿胀程度均高于引流组，其中术后 3 d 分别为［（9.31±4.47）% vs.（7.74±3.75）%］，差异有统计学意义（P=
0.025）。引流组较非引流组术后主动膝关节活动度明显增加（P < 0.001），术后3 d疼痛程度明显增高（P=0.029），术后瘀斑发
生率降低（52.13% vs. 79.25%，P=0.001），但术后深静脉血栓形成（deep venous thrombosis，DVT）发生率差异无统计学意义（P=
0.552）。两组患者术后切口均Ⅰ期甲等愈合，未出现红肿、渗出及脂肪液化等感染情况。引流组引流管未发现引流不畅、持续
出血不愈合、引流管脱出甚至断裂等情况。两组患者随访期内均无感染病例，术后1个月、3个月膝关节功能恢复情况与疼痛
程度差异均无统计学意义（P > 0.05）。结论：TKA术中放置引流可减少HBL，减轻患者术后早期疼痛及肿胀程度。
［关键词］ 膝骨关节炎；人工全膝关节置换术；引流；隐性失血；肿胀；疼痛
［中图分类号］ R687.4 ［文献标志码］ A ［文章编号］ 1007⁃4368（2024）06⁃853⁃07
doi：10.7655/NYDXBNSN240162

The impact of intra⁃articular drains on the efficacy of total knee arthroplasty

TAN Zhenggang，WANG Jinwen，ZHOU Hao，YANG Hui，HUANG Yi，LIU Feng *
Department of Orthopedics Surgery，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，
China

［Abstract］ Objective：The use of drains in total knee arthroplasty（TKA）remains controversial. This study aimed to investigate the
effects of intra⁃articular drainage on blood loss and joint function recovery in TKA. Methods：A retrospective analysis was conducted
on patients with end⁃stage knee osteoarthritis who underwent TKA at the First Affiliated Hospital of Nanjing Medical University from
September 2021 to October 2022. Patients were divided into a drainage group and a non⁃drainage group according to whether drains
were placed intraoperatively. Postoperative blood loss，knee joint functional recovery index，postoperative complications，and follow⁃up
results were compared between the two groups. Results：A total of 147 patients were included，with 53 cases in the non-drainage group
and 94 cases in the drainage group. Compared to the non-drainage group，the drainage group had significantly less hidden blood loss
（HBL）［（906.94±438.41）mL vs.（1 262.85±563.46）mL，P < 0.001］，but there was no significant difference in transfusion rate or total
blood loss（P > 0.05）. The degree of lower limb swelling in the non-drainage group was higher than that in the drainage group at
postoperative day 1，3，and 5，with significant differences noted at postoperative day 3［（9.31±4.47）% vs.（7.74±3.75）%，P=0.025］.
The drainage group showed a significant increase in postoperative range of motion（ROM）of the knee joint compared to the non-
drainage group（P < 0.001），along with a significant increase in postoperative pain at day 3（P=0.029）and a decrease in postoperative
ecchymosis rate（52.13% vs. 79.25% ，P=0.001）. However，there was no statistically significant difference in the incidence of
postoperative deep venous thrombosis（DVT）between the two groups（P=0.552）. Both groups achieved primary healing of the incision
without signs of infection such as redness，discharge，or liquefaction of fat. No cases of drainage obstruction，continuous bleeding at the

［基金项目］ 江苏省自然科学基金（BK20191492）
∗
通信作者（Corresponding author），E⁃mail：njliuf@163.cm