Effects of drainage tube occlusion on drainage volume after total hip arthroplasty

doi:10.3969/j.issn.2095-4344.2014.26.005

Abstract

Abstract:

BACKGROUND: At present, occlusion of the drainage tube was commonly used to reduce the drainage volume after total hip arthroplasty so as to promote the incision healing and hip function rehabilitation. However, the occlusion time is a problem deserving further investigations.
OBJECTIVE: To research the effects of temporarily clamping drainage tube on drainage volume in early stage after total hip arthroplasty.
METHODS: From January to October 2013, 112 patients received unilateral total hip arthroplasty in the First Ward, Department of Orthopedics, First Affiliated Hospital, Zhengzhou University in China. They were randomly divided into four groups according to the admission time (n=28): occlusion of the drainage tube for 2, 4 and 6 hours and without occlusion of the drainage tube. All tubes were pulled out in postoperative 48 hours. Moreover, 48-hour postoperative hemoglobin and drainage volume, the healing of incision and the score of hip joint function when patients were followed up at 1.5 months postoperatively were recorded accurately.
RESULTS AND CONCLUSION: 48-hour hemoglobin drop level and 48-hour incision drainage volume were highest in the non-occlusion group, followed by 2-hour occlusion group, 4-hour occlusion group and 6-hour occlusion group (P < 0.05). However, no significant differences in the healing time of postoperative incision and the Harris score of hip joint function when patients were followed up at 1.5 months postoperatively were detected among groups (P > 0.05). Incision infection and tension split were not seen in each group. Six cases affected subcutaneous ecchymosis and swelling accompanied by pain and four cases suffered from the venous plexus thrombosis of the calf muscle in the 6-hour occlusion group. One case experienced fat liquefaction separately in the 4-hour occlusion group and non-occlusion group. These results suggested that temporary occlusion of the drainage tube in the early stage of total hip arthroplasty could reduce the drainage volume of incision. The suitable time of clamping drainage tube was 4 hours, and there were no adverse effects on healing of incision and recovery of hip function.

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

全文链接：

Key words: arthroplasty, replacement, hip, drainage, hemoglobinometry, wound healing

CLC Number:

R318

Yuan Xiang-wei, Wang Yi-sheng . Effects of drainage tube occlusion on drainage volume after total hip arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(26): 4125-4130.

Figures/Tables 3

2.4 置换后48 h的血红蛋白下降值即刻夹闭引流管2 h组为(30.90±2.54) g/L、即刻夹闭引流管4 h组为(20.74± 2.54) g/L、即刻夹闭引流管6 h组为(18.26±1.96) g/L、不夹闭引流管组为(42.33±2.59) g/L；经LSD-t 检验，显示4组在置换后48 h的血红蛋白下降值两两比较差异有显著性意义(P < 0.05)；经Bonferroni检验，差异亦有显著性意义(P < 0.008 3)。 2.5 置换后48 h切口引流量即刻夹闭引流管2 h组为(264.29±28.86) mL、即刻夹闭引流管4 h组为(176.79± 21.61) mL、即刻夹闭引流管6 h组为(156.79±25.25) mL、不夹闭引流管组为(491.43±20.13) mL；经LSD-t 检验，显示4组置换后48 h切口引流量两两比较差异有显著性意义(P < 0.05)；经Bonferroni检验，差异亦有显著性意义(P < 0.008 3)。 2.6 切口愈合情况即刻夹闭引流管4 h组和不夹闭引流管组各出现1例脂肪液化，无感染、张力性裂开现象，积极进行伤口清理和对症治疗后痊愈；4组病例出院时切口均一期愈合，即刻夹闭引流管2 h组愈合时间为(11.13±1.35) d、即刻夹闭引流管4 h组为(11.46±1.31) d、即刻夹闭引流管6 h组为(12.02±1.02) d、不夹闭引流管组为(11.21±1.13) d，4组间比较差异无显著性意义(P > 0.05)。 2.7 Harris评分置换后1.5个月随访时术肢髋关节功能恢复良好，4组Harris评分分别为：即刻夹闭引流管2 h组为(85.93±3.50)分、即刻夹闭引流管4 h组为(87.18±3.86)分、即刻夹闭引流管6 h组为(86.29±3.52)分、不夹闭引流管组为(87.21±3.34)分，4组组间比较差异无显著性意义(P > 0.05)。 2.8 置换后并发症即刻夹闭引流管6 h组出现6例术肢皮下淤血伴肿胀疼痛和4例术肢小腿肌间静脉血栓，经卧床休息、热敷、消炎止痛药物及血栓通治疗，6例术肢皮下淤血伴肿胀疼痛症状和2例术肢小腿肌间静脉血栓于出院前消失，剩余2例术肢小腿肌间静脉血栓于置换后1.5个月随访时消失。 2.9 典型病例患者，男，50岁，因“双髋关节疼痛7年余，左髋较重”为主诉入院。经入院检查后，诊断为“双侧股骨头坏死(ARCO：Ⅳ期) ”(图2A)，且无手术禁忌证，择期在全麻下行“左侧人工全髋关节置换”(图2B)，按照研究要求进行引流管夹闭6 h(图2C)，置换后第5天左下肢Homans征阳性，复查双下肢静脉超声示左小腿肌间静脉血栓形成(图2D)，及时给予局部热敷等处理，置换后1.5个月随访时血栓消失。"

References

[1]荆鑫,滕红林,吴海山,等.全关节置换术后关节腔引流问题的探讨[J].中国矫形外科杂志,2002,10(z1):1295-1297.
[2]程薇.负压封闭引流术在创伤骨科的围手术期护理体会[J].医学临床研究,2012,29(4):791-792.
[3]Kim YH, Cho SH, Kim RS.Drainage versus nondrainage in simultaneous bilateral total hip arthroplasties.J Arthroplasty. 1998;13(2):156-161.
[4]陈志娜,黄少华,何瑾云,等.术后早期暂时夹管对全髋关节置换术后切口引流量的影响[J].中华护理杂志,2006,41(12): 1096- 1097.
[5]Brueggemann PM, Tucker JK, Wilson P.Intermittent clamping of suction drains in total hip replacement reduces postoperative blood loss: a randomized, controlled trial.J Arthroplasty. 1999;14(4):470-472.
[6]Hallstrom BR, Steele JF. Postoperative course after total hip arthroplasty: wound drainage versus no drainage. Orthop Rev.1992;21(7):847-51.
[7]Parker MJ, Roberts CP, Hay D.Closed suction drainage for hip and knee arthroplasty. A meta-analysis.J Bone Joint Surg Am. 2004;86-A(6):1146-1152.
[8]Walmsley PJ, Kelly MB, Hill RM,et al. A prospective, randomised, controlled trial of the use of drains in total hip arthroplasty.J Bone Joint Surg Br. 2005;87(10):1397-1401.
[9]Han CD, Shin DE.Postoperative blood salvage and reinfusion after total joint arthroplasty.J Arthroplasty. 1997;12(5): 511-516.
[10]Clements DH, Sculco TP, Burke SW,et al.Salvage and reinfusion of postoperative sanguineous wound drainage. A preliminary report.J Bone Joint Surg Am. 1992;74(5):646-651.
[11]Hungerford DS, Krackow KA.A convenient distal plug for the femoral cavity in total hip arthroplasty.Clin Orthop Relat Res. 1981;(154):329-330.
[12]Owens P, Lavernia CJ.Technique for a composite femoral intramedullary plug in cemented hip arthroplasty.J Arthroplasty. 1999;14(3):369-371.
[13]Sharrock NE, Salvati EA.Hypotensive epidural anesthesia for total hip arthroplasty: a review.Acta Orthop Scand. 1996;67(1): 91-107.
[14]Leegwater NC, Willems JH, Brohet R,et al.Cryocompression therapy after elective arthroplasty of the hip.Hip Int. 2012; 22(5):527-533.
[15]Mawatari M, Higo T, Tsutsumi Y,et al.Effectiveness of autologous fibrin tissue adhesive in reducing postoperative blood loss during total hip arthroplasty: a prospective randomised study of 100 cases.J Orthop Surg (Hong Kong). 2006;14(2):117-121.
[16]Brueggemann PM, Tucker JK, Wilson P.Intermittent clamping of suction drains in total hip replacement reduces postoperative blood loss: a randomized, controlled trial.J Arthroplasty. 1999;14(4):470-472.
[17]Hallstrom BR, Steele JF.Postoperative course after total hip arthroplasty: wound drainage versus no drainage.Orthop Rev. 1992;21(7):847-851.
[18]Zhou XD, Tao LJ, Li J,et al.Do we really need tranexamic acid in total hip arthroplasty? A meta-analysis of nineteen randomized controlled trials.Arch Orthop Trauma Surg. 2013; 133(7):1017-1027.
[19]Yamasaki S, Masuhara K, Fuji T.Tranexamic acid reduces postoperative blood loss in cementless total hip arthroplasty.J Bone Joint Surg Am. 2005;87(4):766-770.
[20]Johansson T, Pettersson LG, Lisander B.Tranexamic acid in total hip arthroplasty saves blood and money: a randomized, double-blind study in 100 patients.Acta Orthop. 2005;76(3): 314-319.
[21]戴晓倩,王红,陈莉莉,等.全髋关节置换术后时间引流量与拔管时间的相关性研究[J].临床外科杂志,2009,17(4):270-271.