全髋关节置换术后早期康复中闭合式负压引流方案优化的回顾性分析

doi:10.3877/cma.j.issn.2096-0263.2026.01.007

目的

闭合式负压引流（CSD）常规用于减少外科手术术后血肿形成，如全髋关节置换术（THA）。但拔除引流管后，引流口渗液现象仍长期存在。本研究旨在探讨斜行置管能否有效缩短术后引流口渗液时间并加速THA等外科术后患者康复。

方法

回顾性收集并分析2018年3月至2019年10月在华中科技大学同济医学院附属协和医院行同期双侧初次THA的51例患者，其中男性21例，女性30例；平均年龄（57.9±11.4）岁。每例患者双侧髋关节诊断一致，且患者一侧肢体采用斜行置管，对侧肢体采用传统直行置管作为自身对照。评估指标包括拔管后渗液量及时长、疼痛评分、髋关节功能（HSS评分）及并发症发生率。

结果

两组术后第1天引流量无差异（168.6±17.3 vs 170.2±18.7 mL，t=0.441，P=0.661）。斜行置管渗液持续时间显著缩短（2.4±0.6 vs 3.8±0.8 d，t=9.670，P<0.01），渗液>3 d发生率显著降低（3/51 vs 31/51，χ²=24.5，P<0.05）。24 h、48 h与72 h敷料血渍面积斜行组均显著低于直行组（均P<0.01）。VAS在术后3 d两组差异显著（5.33±0.74 vs 6.24±0.79，F=5.913，P<0.001）。HHS在术后3 d、出院日、术后1月差异均有统计学意义（如术后3 d：51.57±5.63 vs 44.55±4.82，F=6.763，P<0.001）。两组术后第3天血肿厚度无差异（3.8±2.8 vs 4.1±2.5 mm，t=0.464，P=0.645），均未出现深部感染或DVT。

结论

斜行置管可缩短THA术后渗液持续时间并促进早期康复。

关键词: 闭合式负压引流, 斜行置管, 加速康复, 全髋关节置换术

Objective

Closed suction drainage (CSD) is routinely used to reduce postoperative hematoma formation in surgical procedures such as total hip arthroplasty (THA). However, persistent drainage from the drain site often continues after tube removal. This study aimed to investigate whether oblique drain placement can effectively shorten postoperative drain-site drainage duration and promote recovery in patients undergoing THA and similar surgeries.

Methods

A retrospective analysis was conducted on 51 patients (21 males, 30 females; mean age 57.9±11.4 years) who underwent simultaneous bilateral primary THA at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between March 2018 and October 2019. Each patient had the same diagnosis in both hips, with one side receiving oblique drain placement and the contralateral side receiving traditional straight drain placement as an internal control. Outcome measures included drainage volume and duration after tube removal, pain scores, hip function assessed by the Harris Hip Score (HHS), and postoperative complications.

Results

No difference was observed in postoperative day 1 drainage volume between the two techniques (168.6±17.3 vs 170.2±18.7 mL, t=0.441, P=0.661). Oblique drain placement significantly shortened the duration of postoperative drainage (2.4±0.6 vs 3.8±0.8 days, t=9.670, P<0.01) and markedly reduced the incidence of drainage lasting >3 days (3/51 vs 31/51, χ²=24.5, P<0.05). At 24, 48, and 72 hours after tube removal, dressing stain areas were significantly smaller in the oblique placement group (all P<0.01). VAS scores differed significantly between groups on postoperative day 3 (5.33±0.74 vs 6.24±0.79, F=5.913, P<0.001). HHS values showed significant differences at postoperative day 3, discharge, and 1 month (e.g., POD3: 51.57±5.63 vs 44.55±4.82, F=6.763, P<0.001). Hematoma thickness on postoperative day 3 did not differ between groups (3.8±2.8 vs 4.1±2.5 mm, t=0.464, P=0.645), and no deep infection or DVT occurred in any patient.

Conclusion

Oblique drain placement can shorten postoperative drainage duration following THA and facilitate early recovery.

Key words: Closed Suction Drainage, Oblique catheterization, Accelerated recovery, Total hip arthroplasty

图1 纳排流程图

图3 拔出引流管24 h后，斜行-CSD组（a）的血渍面积明显小于直行-CSD组（b）

表1 纳入51例全髋关节置换术患者的人口学资料

项目	数据
病例数	51
男/女（例）	21/30
年龄（岁，±s）	57.9±11.4
身高（cm，±s）	157.8±7.3
体重（kg，±s）	65.6±8.2
BMI（kg/m²，±s）	26.3±2.2
诊断
髋关节炎[例（%）]	19（37.3）
股骨头坏死[例（%）]	32（62.7）

表1 纳入51例全髋关节置换术患者的人口学资料

项目	数据
病例数	51
男/女（例）	21/30
年龄（岁，±s）	57.9±11.4
身高（cm，±s）	157.8±7.3
体重（kg，±s）	65.6±8.2
BMI（kg/m²，±s）	26.3±2.2
诊断
髋关节炎[例（%）]	19（37.3）
股骨头坏死[例（%）]	32（62.7）

表2 两组全髋关节置换术患者术后参数比较（

±s，n=51）

组别	术后第一天引流量（ml）	伤口深度（cm）	拔管后渗液时间（d）	渗液超3天例数（例）	术后3天血肿情况（mm）
斜行-CSD	168.6±17.3	3.1±0.6	2.4±0.6	3/51	4.0（1.6，6.1）
直行-CSD	170.2±18.7	3.0±0.5	3.8±0.8	31/51	4.0（2.6，5.8）
χ²/t值	0.441	-0.934	9.670	24.5	1 227.5
P值	0.661^a	0.355^a	<0.01^a	<0.05^b	0.627^c

表2 两组全髋关节置换术患者术后参数比较（

±s，n=51）

组别	术后第一天引流量（ml）	伤口深度（cm）	拔管后渗液时间（d）	渗液超3天例数（例）	术后3天血肿情况（mm）
斜行-CSD	168.6±17.3	3.1±0.6	2.4±0.6	3/51	4.0（1.6，6.1）
直行-CSD	170.2±18.7	3.0±0.5	3.8±0.8	31/51	4.0（2.6，5.8）
χ²/t值	0.441	-0.934	9.670	24.5	1 227.5
P值	0.661^a	0.355^a	<0.01^a	<0.05^b	0.627^c

表3 两组全髋关节置换术患者拔管后敷料血渍面积比较（cm²，

±s，n=51）

组别	24 h	48 h	72 h	χ²值	P值
斜行-CSD	12.10（9.85，14.00）	1.70（1.40，2.75）^*	0.60（0.40，0.80）^*#	102.000	<0.001
直行-CSD	129.50（119.60，193.45）	72.10（62.30，85.50）^*	5.80（1.65，11.70）^*#	98.420	<0.001
Z值	-8.621	-8.610	-7.530
P值	<0.001	<0.001	<0.001

表3 两组全髋关节置换术患者拔管后敷料血渍面积比较（cm²，

±s，n=51）

组别	24 h	48 h	72 h	χ²值	P值
斜行-CSD	12.10（9.85，14.00）	1.70（1.40，2.75）^*	0.60（0.40，0.80）^*#	102.000	<0.001
直行-CSD	129.50（119.60，193.45）	72.10（62.30，85.50）^*	5.80（1.65，11.70）^*#	98.420	<0.001
Z值	-8.621	-8.610	-7.530
P值	<0.001	<0.001	<0.001

表4 两组全髋关节置换术患者Harris髋关节评分比较（

±s，n=51）

组别	术前	术后3天	出院日	术后1月	术后3月	F值	P值
斜行-CSD	41.71±7.95	51.57±5.63^*	64.45±4.82^*#	79.02±4.52^*#&	87.98±3.74^*#&%	605.237	0.000
直行-CSD	40.55±7.47	44.55±4.82^*	57.88±4.61^*#	76.96±5.13^*#&	87.10±3.38^*#&%	754.773	0.000
F值	0.758	6.763	7.034	2.15	1.25
P值	0.45	<0.001	<0.001	0.034	0.214

表4 两组全髋关节置换术患者Harris髋关节评分比较（

±s，n=51）

组别	术前	术后3天	出院日	术后1月	术后3月	F值	P值
斜行-CSD	41.71±7.95	51.57±5.63^*	64.45±4.82^*#	79.02±4.52^*#&	87.98±3.74^*#&%	605.237	0.000
直行-CSD	40.55±7.47	44.55±4.82^*	57.88±4.61^*#	76.96±5.13^*#&	87.10±3.38^*#&%	754.773	0.000
F值	0.758	6.763	7.034	2.15	1.25
P值	0.45	<0.001	<0.001	0.034	0.214

表5 两组全髋关节置换术患者视觉模拟评分比较（

±s，n=51）

组别	术前	术后3天	出院日	术后1月	术后3月	F值	P值
斜行-CSD	7.61±0.83	5.33±0.74^*	3.76±0.59^*#	2.47±0.61^*#&	1.92±0.48^*#&%	603.133	0.000
直行-CSD	7.55±0.90	6.24±0.79^*	3.90±0.67^*#	2.67±0.52^*#&	2.10±0.54^*#&%	568.72	0.000
F值	0.343	-5.954	-1.100	-1.749	-1.741
P值	0.732	<0.001	0.274	0.083	0.085

表5 两组全髋关节置换术患者视觉模拟评分比较（

±s，n=51）

组别	术前	术后3天	出院日	术后1月	术后3月	F值	P值
斜行-CSD	7.61±0.83	5.33±0.74^*	3.76±0.59^*#	2.47±0.61^*#&	1.92±0.48^*#&%	603.133	0.000
直行-CSD	7.55±0.90	6.24±0.79^*	3.90±0.67^*#	2.67±0.52^*#&	2.10±0.54^*#&%	568.72	0.000
F值	0.343	-5.954	-1.100	-1.749	-1.741
P值	0.732	<0.001	0.274	0.083	0.085

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Retrospective analysis of the optimization of closed suction drainage regimens in early rehabilitation after total hip arthroplasty

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Retrospective analysis of the optimization of closed suction drainage regimens in early rehabilitation after total hip arthroplasty