摘要
目的 探讨引流管放置与否对初次全膝关节置换术（TKA）后康复的影响。方法 回顾性分析内江市中医医院2020年1月至2022年5月本院膝关节炎初次接受TKA的患者，均行加速康复外科(ERAS)模式进行管理，A组术后放置引流管，B组术后不放置引流管，比较术后患者疼痛评分（VAS）、膝关节功能评分（HSS）、深静脉血栓发生率、切口感染、血清炎症因子CRP指标、下地活动时间、住院时长。结果 术后两组疼痛、膝关节功能、深静脉血栓发生率、切口感染率、血清炎症因子指标（CRP）均无显著性差异，差异无统计学意义（P＞0.05）。B组下地活动时间较A组早，B组住院时长较A组住院时长短，差异有统计学意义（P＜0.05）。结论 TKA可明显改善膝关节功能，术后引流管放置与否不影响患者术后疼痛、术后并发症、血清炎症因子指标，但不放置引流管可早期下地活动，缩短住院时间，促进患者康复。
关键词： 膝关节炎；全膝关节置换术；引流管；加速康复外科
Abstract
Objective To investigate the effect of drainage tube placement on rehabilitation after primary total knee arthroplasty (TKA). Methods: Retrospective analysis was made on the patients who received TKA for the first time in Neijiang Hospital of Traditional Chinese Medicine from January 2020 to May 2022. All patients were managed by the enhanced recovery after surgery (ERAS) model. In group A, drainage tubes were placed postoperatively, while in group B, no drainage tubes were placed postoperatively. The postoperative pain score (VAS), knee joint function score (HSS), incidence of deep vein thrombosis, incision infection, serum inflammatory factor CRP index, time of underground activity Length of hospital stay. Results: There was no significant difference between the two groups in pain, knee joint function, incidence of deep vein thrombosis, wound infection rate, and serum inflammatory factor (CRP) index (P>0.05). The time of ground activity in group B was earlier than that in group A, and the length of hospitalization in group B was longer than that in group A, with a statistically significant difference (P<0.05). Conclusion : TKA can significantly improve the function of knee joint. The placement of drainage tube after operation does not affect the postoperative pain, postoperative complications, and serum inflammatory factor indicators of patients. However, without drainage tube, patients can move to the ground early, shorten the hospital stay, and promote the recovery of patients.
Key words： Knee arthritis; TKA; Drainage tube; ERAS
参考文献 References
[1] Sharma L.Osteoarthritis of the Knee.N Engl J Med.2021 Jan 7;384(1):51-59.
[2] Jingyi Li,Haibei Zhu,Ren Liao,Enhanced recovery aftersurgery (ERAS) pathway for primary hip and knee arthroplasty: study protocol for a randomized controlled trial[J].Trials.2019 Oct 22;20(1):599.
[3] 裴福兴,翁习生,黄泽宇,积极推进“创建骨科手术加速康复围手术期血液与疼痛管理示范病房”活动[J].中华骨与关节外科杂志,2019,12(02),161-166.
[4] Thomas W Wainwright,Enhanced Recovery after Surgery (ERAS) for Hip and Knee Replacement-Why and How It Should Be Implemented Following the COVID-19 Pandemic Medicina (Kaunas).2021 Jan 19;57(1):81.
[5] Håkan Nero,Anna Cronström,Allan Abbott，Swedish osteoarthritis treatment at the forefront[J].Lakartidningen.2021 Jul 5;118:20205.
[6] Marianna Vitaloni,Angie Botto-van Bemden,Rosa Maya Sciortino Contreras,et al.Global management of patients with knee osteoarthritis begins with quality of life assessment: a systematic review[J].BMC Musculoskelet Disord.2019 Oct 27;20(1):493.
[7] Johannes Beckmann,Malin Kristin Meier,Christian Benignus,et al，Contemporary knee arthroplasty: one fits all or time for diversity?[J].Arch Orthop Trauma Surg.2021 Dec;141(12):2185-2194.
[8] 王聪，张国荣，解桐，等，膝关节骨性关节炎全膝关节置换术后患者满意度影响因素研究进展[J].中国骨与关节损伤杂志,2021,36(08),891-894
[9] Dun Wang,Tao Wu,Yi Li,et al,A systematic review and meta-analysis of the effect of preoperative exercise intervention on rehabilitation after total knee arthroplasty[J].Ann Palliat Med. 2021 Oct;10(10):10986-10996.
[10] 张驰,庞素芳,王彤,等，基于康复评定的加速康复外科干预对髋膝关节置换功能恢复的影响[J].中国康复医学杂,2022,37(07),967-970
[11] 冯志军,赵艳丽,张虎,等.人工全膝关节置换术后放置与不放置引流管对失血情况及关节功能的影响[J].临床误诊误治，2021,34(02),74-77.
[12] 文鹏飞，郝林杰，马涛，等，初次关节置换术中引流管应用的研究进展[J].中华骨与关节外科杂志，2020,13(10),870-873
[13] 文鹏飞,郝林杰,马涛,等,初次关节置换术中引流管应用的研究进展[J].中华骨与关节外科杂志,2020,13(10),870-873
[14] 刘四海,王飞,韩新作,等,初次全膝关节置换术后放置与不放置引流对术后快速康复的影响[J].中国康复理论与实践2021,27(08),962-965.