中国组织工程研究

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (33): 5371-5378.doi: 10.3969/j.issn.2095-4344.2889

• 骨与关节综述 bone and joint review • 上一篇    下一篇

全膝关节置换后不放置引流的相关管理策略

侯森荣1，杨伟毅2，罗明辉2，潘建科2，黄和涛1，曾令烽2，刘  军2，梁桂洪2   

  1. 1广州中医药大学第二临床医学院，广东省广州市   510405；2广州中医药大学第二附属医院(广东省中医院)骨关节科，广东省广州市   510120

  • 收稿日期:2020-02-26 修回日期:2020-03-05 接受日期:2020-03-30 出版日期:2020-11-28 发布日期:2020-10-13
  • 通讯作者: 刘军，主任医师，教授，博士后合作导师，广州中医药大学第二附属医院(广东省中医院)骨关节科，广东省广州市 510120
  • 作者简介:侯森荣，男，1993年生，广东省揭阳市人，汉族，广州中医药大学第二临床医学院在读硕士，主要从事中医药治疗骨伤科疾病方面的研究。
  • 基金资助:
    广东省财政厅项目([2014]157号，[2018]8号)；广东省中医院中医药科学技术研究专项(YN2019ML08，YK2013B2N19)；广东省中医院中医药科学技术研究专项(YN2015MS15)

Perioperative management strategy without drainage tube after total knee arthroplasty

Hou Senrong1, Yang Weiyi2, Luo Minghui2, Pan Jianke2, Huang Hetao1, Zeng Lingfeng2, Liu Jun2, Liang Guihong2   

  1. 1Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 2Department of Orthopedics, Second Affiliated Hospital (Guangdong Provincial Hospital of Traditional Chinese Medicine) of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China

  • Received:2020-02-26 Revised:2020-03-05 Accepted:2020-03-30 Online:2020-11-28 Published:2020-10-13
  • Contact: Liu Jun, Chief physician, Professor, Post-doctoral cooperative-supervisor, Department of Orthopedics, Second Affiliated Hospital (Guangdong Provincial Hospital of Traditional Chinese Medicine) of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
  • About author:Hou Senrong, Master candidate, Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:
    the Project of Guangdong Provincial Department of Finance, Nos. [2014]157, [2018]8; the Science and Technology Research Project of Guangdong Provincial Hospital of Traditional Chinese Medicine, No. YN2019ML08, YK2013B2N19, No. YN2015MS15

PDF

155

摘要：

文题释义：

自体血回输引流：也隶属于闭式负压引流的范畴，可在不增加肺栓塞、脂肪栓塞及不明显影响凝血功能、不增加感染概率的前提下有效降低输血率。

快速康复：是近年来提出的一种理论，旨在通过在术前、术中及术后应用各种已证实有效的方法以减少患者手术应激及并发症，加速患者术后康复。

背景：近年来，随着全膝关节置换技术提升、手术时间缩短、术中及术后止血药的应用，其总失血量不断减少，术后引流量也逐渐减少，术后快速康复理论应运而生，引流管放置也再次成为骨科医生所热议的问题，越来越多的医生认为可以常规取消放置引流，引流似乎已可有可无。

目的：旨在复习既往文献，对全膝关节置换后引流放置的相关问题归纳总结，提供围术期引流管理的相关经验。

方法：检索中国知网、万方、维普、中国生物医学文献数据库等中文数据库，以及PubMed、The Cochrane Library、Web of Science、EMBASE、OVID等外文数据库，以“引流，膝关节置换术”及“total knee arthroplasty，drainage”为检索词，检索自建库始至2020年2月为止所有与主题相关的文献，总结归纳全膝关节置换后不放置引流管围术期各方面需综合考虑的要素。

结果与结论：①引流管的放置问题关乎全膝关节置换手术的最终结果，与术后出血、血肿、血栓、感染等并发症的发生关系密切；②目前全膝关节置换术后不推荐常规放置引流，但不意味着不需要管理，其实际上对临床医护在围术期各方面的管理提出更高的要求，包括但不限于术前适应证选择、手术操作、止血带使用、术中及术后药物使用、物理疗法的使用等。

ORCID: 0000-0002-3391-3565(侯森荣)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨, 关节, 引流, 膝, 关节置换, 围手术期, 出血, 综述

Abstract:

BACKGROUND: In recent years, with the improvement of total knee arthroplasty technology, the shortening of operation time, the application of hemostatic drugs during and after operation, the total loss of blood is decreasing, and the postoperative drainage flow is also decreasing. The theory of postoperative rapid rehabilitation emerges at the historic moment, and the placement of drainage tube is once again a hot issue for orthopedic doctors. More than a few doctors think that the placement of drainage can be cancelled routinely, and drainage seems to be nonexistent.

OBJECTIVE: To review the previous literature, to summarize the relevant problems of drainage placement after total knee arthroplasty and provide relevant experience of drainage management.

METHODS: Literature retrieval includes Chinese databases such as CNKI, Wanfang, VIP, China biomedical literature database, and English databases such as PubMed, the Cochrane Library, Web of Science, EMBASE, and Ovid. The Chinese key words were “drainage, knee arthroplasty”. The English key words were “total knee arthroplasty, drainage”. All the literature related to the theme from inception to February 2020. The factors that need to be considered comprehensively in all aspects of perioperative period without drainage tube after total knee replacement were summed up.

RESULTS AND CONCLUSION: (1) The placement of drainage tube is closely related to the final result of operation and the occurrence of postoperative complications such as hemorrhage, hematoma, thrombus and infection. (2) At present, conventional placement of drainage tube is not recommended after total knee arthroplasty, but it does not mean that there is no need for management. In fact, it puts forward higher requirements for the management of clinical doctors and nurses in all aspects of perioperative period, including but not limited to the selection of indications before surgery, surgical operation, tourniquet use, intraoperative and postoperative drug use, and physical therapy use. 

Key words: bone, joint, drainage, knee, joint replacement, perioperative period, hemorrhage, review

中图分类号: