摘要
目的:系统评价初次人工膝关节表面置换术(total knee arthroplasty,TKA)后放置与不放置引流的临床疗效及并发症情况,为临床实践提供参考。方法:按照系统评价的要求全面检索MEDLINE、EMBASE、Cochrane Library以及CNKI,收集筛选初次TKA术后留置与不留置引流的前瞻性随机对照研究(randomized controlled trils,RCTs),采用CONSORT的22条标准对文献质量进行评分,并应用RevMan Version 5.0软件对数据进行Meta分析。分析结果显示有异质性存在时,依据手术侧别及止血带放气时机进行亚组分析。结果:共纳入16项随机对照研究,共计1 417例膝(引流组713例,无引流组704例)。在软组织瘀斑发生率方面,引流组明显优于无引流组且亚组分析显示一期双膝关节置换时,此差异更加明显;在失血情况方面,无引流组的总失血量及输血率则明显低于引流组;最后,2组的感染、深静脉血栓(deep venous thrombosis,DVT)发生率及关节活动度的差异均无统计学意义。结论:现有的RCTs结果显示,初次TKA术后留置引流并不能显著降低感染及DVT的发生率和增加关节活动度,反而会增加患者总失血量和输血率,其唯一的优势在于可减少术后软组织瘀斑发生率。
Objective： To compare the clinical outcome between closed suction drainage and nondrainage following primary total knee arthroplasty（TKA） on the basis of the best available evidence. Methods：Randomized controlled trils （RCTs） between 1950 and December 2013 comparing primary TKA patients managed with closed-suction drainage and those without drainage in the databases of Medline, EMBASE, Cochrane Library and CNKI were enrolled. The Review Mananger was used to analyze selected studies. Twenty- two CONSORT criteria were used to evaluate the the quality of the literature. Subgroup analysis was carried out when significant het- erogeneity occured. Results： Sixteen RCTs involving 1 417 knees（713 knees in closed-suction drainage group and 704 in nondrainage group） satisfied the inclusion criteria. In closed-suction drainage group,the incidence of soft tissue ecchymosis was significantly lower compared with that in nondrainage group. Subgroup analysis showed greater differences between the two groups in the setting of simul- taneous bilateral TKA. However, results favored nondrainage group with respect to the total blood loss volume and blood transfusion rates. No significant difference was demonstrated in the prevalence of infection,incidence of deep venous thrombosis（DVT）, or postoperative range of motion （ROM） between two groups. Conclusion：Current RCTs demonstrate that the use of closed suction drainage after primary TKA provides no benefit in terms of infection, DVT, and postoperative ROM when compared with nondrainage. Besides,it increases perioperative total blood loss volume and elevates the risk of homologous blood transfusion. The only proven advantage of drainage is a decreased incidence of blood leakage from the wound, especially when simultaneous bilateral TKA is performed.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2014年第8期1139-1144,共6页
Journal of Chongqing Medical University
基金
国家高技术研究发展计划(863计划)资助项目(编号:2013AA031903)
关键词
膝关节置换术
引流术
META分析
total knee arthroplasty
closed suction drainage
Meta-analysis
