导航TKA术后引流放置与否对患者预后影响：一项队列研究

doi:10.3877/cma.j.issn.2096-0263.2025.06.002

目的

探究计算机导航全膝关节置换术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

前瞻性收集2022年10月至2023年12月于我院行初次单侧计算机导航全膝关节置换的100例患者。采用随机数字表法决定关闭切口前是否放置负压引流管，从而将患者分为引流组（50例）和非引流组（50例），其余治疗相同。100例患者获得随访，随访时间10~24个月，平均（15.39±4.46）个月。其中男19例，女81例。引流组平均年龄（66.90±6.43）岁，非引流组平均年龄（66.04±6.32）岁。对比两组患者术后失血情况，记录术后关节功能指标及并发症发生情况，并进行统计分析。

结果

①两组隐性失血、总失血量差异无统计学意义（P>0.05）。②两组术后第3天、3个月、6个月膝关节活动度及术前、3个月及6个月时HSS评分及WOMAC评分进行重复测量设计的方差分析显示组间差异无统计学意义（P>0.05），组别与时间点间未观察到显著的交互作用（P>0.05），不同时间点间差异有统计学意义（P<0.05）。③两组出院术后切口渗出天数、住院时间并发症发生率差异无统计学意义（P>0.05）。④两组患者术后切口均Ⅰ期甲等愈合。

结论

计算机导航全膝关节置换术后放置引流管与否对术后失血及膝关节功能恢复、术后并发症的发生无明显影响。

关键词: 膝关节骨关节炎, 全膝关节置换术, 计算机导航手术, 负压引流

Objective

To investigate the effect of intraoperative placement of intra-articular drainage on postoperative blood loss and functional recovery in computer-navigated total knee arthroplasty (TKA).

Methods

A total of 100 patients who underwent primary unilateral computer-navigated TKA at our hospital between October 2022 and December 2023 were included. Patients were divided into a drainage group (50 cases) and a non-drainage group (50 cases) based on whether a negative-pressure drainage tube was placed before wound closure, with all other treatments being identical. All 100 patients were followed up for 10-24 months (mean 15.39±4.46 months). The cohort included 19 males and 81 females, with a mean age of 66.90±6.43 years in the drainage group and 66.04±6.32 years in the non-drainage group. Postoperative blood loss, joint functional indicators, and complications were compared between the two groups, followed by statistical analysis.

Results

① No statistically significant difference was found in hidden blood loss or total blood loss between the two groups (P>0.05). ② Repeated measures ANOVA of knee range of motion (ROM) on postoperative day 3, month 3, and month 6, as well as HSS scores and WOMAC scores preoperatively and at months 3 and 6, revealed no significant intergroup differences and no interaction between group and time points. Significant differences were observed across time points. ③ No statistically significant differences were found in postoperative wound exudation duration, hospital stay, or complication rates (P>0.05). ④ All incisions healed primarily without complications in both groups.

Conclusion

Placement of a drainage tube after computer-navigated TKA has no significant effect on postoperative blood loss, functional recovery of the knee joint, or the incidence of postoperative complications.

Key words: Knee osteoarthritis, Total knee arthroplasty, Computer-assisted surgery, Suction drainage

图1 两例典型患者影像学资料。图a　患者女，71岁，引流组，诊断：右膝关节骨性关节炎。图示膝关节置换术前术后膝关节正侧位。图b　患者女，70岁，非引流组，诊断：左膝关节骨性关节炎。图示膝关节置换术前术后膝关节正侧位。手术均由左建林教授主刀完成，术后假体角度精准

表1 两组全膝关节置换术患者一般资料比较

组别	例数	年龄（岁，±s）	身高（cm，±s）	体重（kg，±s）	性别（例）
组别	例数	年龄（岁，±s）	身高（cm，±s）	体重（kg，±s）	男	女
A组	50	66.90±6.43	159.94±15.05	70.56±11.50	11	39
B组	50	66.04±6.32	161.84±6.36	69.41±9.44	8	42
t/χ²值		0.647	0.822	0.549	0.300
P值		0.502	0.413	0.585	0.610

表1 两组全膝关节置换术患者一般资料比较

组别	例数	年龄（岁，±s）	身高（cm，±s）	体重（kg，±s）	性别（例）
组别	例数	年龄（岁，±s）	身高（cm，±s）	体重（kg，±s）	男	女
A组	50	66.90±6.43	159.94±15.05	70.56±11.50	11	39
B组	50	66.04±6.32	161.84±6.36	69.41±9.44	8	42
t/χ²值		0.647	0.822	0.549	0.300
P值		0.502	0.413	0.585	0.610

表2 两组全膝关节置换术患者术后失血情况比较

组别	例数	渗血天数[d，M（Q₁,Q₃）]	隐性失血量[ml，M（Q₁,Q₃）]	总失血量（ml，±s）
A组	50	4（1，4）	517.10（249.79，854.39）	893.63±324.43
B组	50	4（1，4）	442.03（226.44，836.36）	852.66±304.94
Z/t值		0.360	0.310	0.651
U值		1302.5	1295.0	/
P值		0.581	0.796	0.517

表2 两组全膝关节置换术患者术后失血情况比较

组别	例数	渗血天数[d，M（Q₁,Q₃）]	隐性失血量[ml，M（Q₁,Q₃）]	总失血量（ml，±s）
A组	50	4（1，4）	517.10（249.79，854.39）	893.63±324.43
B组	50	4（1，4）	442.03（226.44，836.36）	852.66±304.94
Z/t值		0.360	0.310	0.651
U值		1302.5	1295.0	/
P值		0.581	0.796	0.517

表3 两组全膝关节置换术患者膝关节活动度比较（度，

±s）

组别	例数	术后3 d膝关节活动度	术后3个月膝关节活动度	术后6个月膝关节活动度	F_组别	P_组别
A组	50	58.40±23.44	92.90±11.34	105.80±8.10	0.018	0.894
B组	50	56.80±24.47	92.40±13.76	108.80±8.72	0.018	0.894
F_时间		304.257
P_时间		0.000

表3 两组全膝关节置换术患者膝关节活动度比较（度，

±s）

组别	例数	术后3 d膝关节活动度	术后3个月膝关节活动度	术后6个月膝关节活动度	F_组别	P_组别
A组	50	58.40±23.44	92.90±11.34	105.80±8.10	0.018	0.894
B组	50	56.80±24.47	92.40±13.76	108.80±8.72	0.018	0.894
F_时间		304.257
P_时间		0.000

表4 两组全膝关节置换术患者WOMAC评分比较（分，

±s）

组别	例数	术前WOMAC评分	术后3个月WOMAC评分	术后6个月WOMAC评分	F_组别	P_组别
A组	50	94.28±40.45	19.76±7.15	9.28±4.90	0.004	0.947
B组	50	93.44±35.38	19.74±8.21	9.60±4.78	0.004	0.947
F_时间		437.232
P_时间		0.000

表4 两组全膝关节置换术患者WOMAC评分比较（分，

±s）

组别	例数	术前WOMAC评分	术后3个月WOMAC评分	术后6个月WOMAC评分	F_组别	P_组别
A组	50	94.28±40.45	19.76±7.15	9.28±4.90	0.004	0.947
B组	50	93.44±35.38	19.74±8.21	9.60±4.78	0.004	0.947
F_时间		437.232
P_时间		0.000

表5 两组全膝关节置换术患者HSS评分比较（分，

±s）

组别	例数	术前HSS评分	术后3个月HSS评分	术后6个月HSS评分	F_组别	P_组别
A组	50	61.57±10.08	83.08±4.79	91.44±3.16	0.252	0.617
B组	50	62.44±9.85	82.00±6.97	90.14±4.30	0.252	0.617
F_时间		609.465
P_时间		0.000

表5 两组全膝关节置换术患者HSS评分比较（分，

±s）

组别	例数	术前HSS评分	术后3个月HSS评分	术后6个月HSS评分	F_组别	P_组别
A组	50	61.57±10.08	83.08±4.79	91.44±3.16	0.252	0.617
B组	50	62.44±9.85	82.00±6.97	90.14±4.30	0.252	0.617
F_时间		609.465
P_时间		0.000

表6 两组全膝关节置换术患者术后并发症率比较

组别	例数	下肢深静脉血栓形成		住院时间（d，±s）
组别	例数	有	无	住院时间（d，±s）
A组	50	1	49	7.34±1.53
B组	50	1	49	7.52±1.81
χ²值		0		0.537
P值		1		0.593

表6 两组全膝关节置换术患者术后并发症率比较

组别	例数	下肢深静脉血栓形成		住院时间（d，±s）
组别	例数	有	无	住院时间（d，±s）
A组	50	1	49	7.34±1.53
B组	50	1	49	7.52±1.81
χ²值		0		0.537
P值		1		0.593

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Impact of suction drainage on patient outcomes following computer-assisted total knee arthroplasty: A cohort study

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Impact of suction drainage on patient outcomes following computer-assisted total knee arthroplasty: A cohort study