初次髋关节置换术后引流与否的Meta分析

doi:10.6040/j.issn.1671-7554.0.2015.757

摘要/Abstract

摘要： 目的通过Meta分析比较放置引流对髋关节置换术的疗效及安全性。方法计算机检索PubMed、EBSCO、The Cochrane Library、万方数据库、中国知网等中英文数据库,检索2000年1月至2015年8月关于髋关节置换术后引流与不引流的临床随机对照研究。按纳入、排除标准进行筛查和质量评估,采用RevMan 5.2软件进行Meta分析。结果纳入20个研究,2 270例患者,引流组1 134例,不引流组1 136例。Meta分析显示:与不引流组相比,髋关节置换术后引流不能显著减少患者感染率(RR=0.75,95%CI: 0.49~1.14,P =0.18)、血肿形成率(RR=0.98,95%CI: 0.25~3.91,P =0.98)、深静脉血栓(RR=2.56,95%CI: 0.86~7.68,P=0.09)、肺栓塞(RR=2.37,95%CI: 0.35~15.94,P=0.38)及疼痛,但显著增加患者输血率(RR=1.36,95%CI: 1.58,P<0.001)、输血量(WMD=0.64,95%CI: 0.21~1.07,P<0.05)及失血量(WMD=277.80, 95%CI: 118.88~436.73,P<0.05)。结论髋关节置换术后放置引流管与不放置相比无明显优势。

关键词: 疗效, Meta分析, 引流, 安全性, 髋关节置换

Abstract: Objective To explore the efficacy and safety of wound drainage in hip arthroplasty by meta-analysis. Methods The criteria for inclusion and exclusion were formulated. The following databases were searched, including PubMed, EBSCO, Cochrane Library, WanFang Database and China National Knowledge Infrastructure(CNKI)for studies published during Jan. 2000 and Aug. 2015, and then the randomized trials on hip arthroplasty with wound drainage system and without drainage system were compared. Meta-analysis were conducted with Review Manager 5.2. Results A total of 20 studies involving 2 270 participants(1 134 drains and 1 136 without drains)were included in our meta-analysis. There was no significant difference in the incidence of wound infections (RR=0.75, 95%CI: 0.49-1.14, P=0.18), wound hematomas(RR=0.98, 95%CI: 0.25-3.91, P=0.98), deep vein thrombosis (RR=2.56, 95%CI: 0.86-7.68, P=0.09), pulmonary embolism(RR=2.37, 95%CI: 0.35-15.94, P=0.38)or pain between the two groups. Our results demonstrated blood transfusion(RR=1.36, 95%CI: 1.18-1.58, P<0.001), transfusion unit(WMD=0.64, 95%CI: 0.21-1.07, P<0.05)and blood loss(WMD=277.80, 95%CI: 118.88-436.73, P<0.05)were more frequent in those who received drains. Conclusion The routine use of wound drainage for hip arthroplasty has no obvious advantages. However, there is a moderate possibility of selection bias and publication bias in this review. More samples and high-quality randomized trials are needed to increase the reliability of evidences.

Key words: Drainage, Safety, Hip arthroplasty, Effectiveness, Meta-analysis

中图分类号:

R681.6

徐闯,戚大春,李贤让,祖萌,李健,刘明廷. 初次髋关节置换术后引流与否的Meta分析[J]. 山东大学学报（医学版）, 2016, 54(6): 43-49.

XU Chuang, QI Dachun, LI Xianrang, ZU Meng, LI Jian, LIU Mingting. Do we really need wound drainage in hip arthroplasty? A meta-analysis[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(6): 43-49.

参考文献

[1] Zhou X, Li J, Xiong Y, et al. Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis[J]. Int Orthop, 2013, 37(11):2109-2118.
[2] Li N, Li P, Liu M, et al. Comparison between autologous blood transfusion drainage and no drainage/closed-suction drainage in primary total hip arthroplasty:a meta-analysis[J]. Arch Orthop Trauma Surg, 2014, 134(11):1623-1631.
[3] Crevoisier XM, Reber P, Noesberger B. Is suction drainage necessary after total joint arthroplasty?[J]. Arch Orthop Trauma Surg, 1998, 117(3):121-124.
[4] Garvin KL, Konigsberg BS. Infection following total knee arthroplasty[J]. J Bone Joint Surg Am, 2011, 93(12):1167-1175.
[5] Matar WY, Jafari SM, Restrepo C, et al. Preventing infection in total joint arthroplasty[J]. J Bone Joint Surg Am, 2010, 92(Supplement 2):36-46.
[6] Chen Z, Gao Y, Chen W, et al. Is wound drainage necessary in hip arthroplasty? A meta-analysis of randomized controlled trials[J]. Eur J Orthop Surg Traumatol, 2014, 24(6):939-946.
[7] Niskanen RO, Korkala OL, Haapala J, et al. Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis:a prospective randomized study[J]. J Arthroplasty, 2000, 15(5):567-569.
[8] Ravikumar KJ, Alwan T, Fordyce MJF, et al. Drainage versus non-drainage in total hip arthroplasty. A prospective randomised study[J]. Hip Int, 2001, 11(1):49-54.
[9] Mengal B, Aebi J, Rodriguez A, et al. A prospective randomized study of wound drainage versus non-drainage in primary total hip or knee arthroplasty[J]. Rev Chir Orthop Reparatrice Appar Mot, 2001, 87(1):29-39.
[10] Widman J, Jacobsson H, Larsson SA, et al. No effect of drains on the postoperative hematoma volume in hip replacement surgery:a randomized study using scintigraphy[J]. Acta Orthop Scand, 2002, 73(6):625-629.
[11] González DVA, Slullitel G, Vestri R, et al. No need for routine closed suction drainage in elective arthroplasty of the hip:a prospective randomized trial in 104 operations[J]. Acta Orthop Scand, 2004, 75(1):30-33.
[12] Johansson T, Engquist M, Pettersson LG, et al. Blood loss after total hip replacement:a prospective randomized study between wound compression and drainage[J]. J Arthroplasty, 2005, 20(8):967-971.
[13] Walmsley PJ, Kelly MB, Hill RMF, et al. A prospective, randomised, controlled trial of the use of drains in total hip arthroplasty[J]. J Bone Joint Surg Br, 2005, 87(10):1397-1401.
[14] Matsuda K, Nakamura S, Wakimoto N, et al. Drainage does not increase anemia after cementless total hip arthroplasty[J]. Clin Orthop Relat Res, 2007, 458:101-105.
[15] Dora C, von Campe A, Mengiardi B, et al. Simplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations[J]. Arch Orthop Trauma Surg, 2007, 127(10):919-923.
[16] 杨东, 张伟, 孙水, 等. 初次全髋关节置换术后引流管应用的必要性探讨[J]. 山东医药, 2008, 48(18):88-89.
[17] 陈巧玲, 全小明. 全髋关节置换术后引流放置的对比研究[J]. 护士进修杂志, 2009, 24(4):295-296.
[18] Strahovnik A, Fokter SK, Kotnik M. Comparison of drainage techniques on prolonged serous drainage after total hip arthroplasty[J]. J Arthroplasty, 2010, 25(2):244-248.
[19] Cheung G, Carmont MR, Bing AJ, et al. No drain, autologous transfusion drain or suction drain? A randomised prospective study in total hip replacement surgery of 168 patients[J]. Acta Orthop Belg, 2010, 76(5):619-627.
[20] 孙建辉. 加压包扎与负压引流预防全髋关节置换术后失血量效果比较[J]. 实用医药杂志, 2010, 27(3):202-204.
[21] Kleinert K, Werner C, Mamisch-Saupe N, et al. Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach[J]. Arch Orthop Trauma Surg, 2012, 132(1):131-136.
[22] von Roth P, Perka C, Dirschedl K, et al. Use of Redon drains in primary total hip arthroplasty has no clinically relevant benefits[J]. Orthopedics, 2012, 35(11):e1592-5.
[23] 陈科, 吕小华, 曾荣, 等. 初次髋关节置换后不放置引流管的安全性[J]. 中国组织工程研究, 2012, 16(35):6494-6497.
[24] Zeng W, Zhou K, Zhou Z, et al. Comparison between Drainage and Non-drainage after Total Hip Arthroplasty in Chinese Subjects[J]. Orthop Surg, 2014, 6(1):28-32.
[25] 鲁娟, 陈珍珍, 洪雪佩, 等. 全髋关节置换术切口不引流的临床应用及效果观察[J]. 中国现代医生, 2014, 52(33):124-126.
[26] Koyano G, Jinno T, Koga D, et al. Is closed suction drainage effective in early recovery of hip joint function? Comparative evaluation in one-stage bilateral total hip arthroplasty[J]. J Arthroplasty, 2015, 30(1):74-78.
[27] Snell S. On the suction-operation for cataract[J]. Br Med J, 1876, 1(802):595.
[28] Howe L. On the removal of hard cataract by suction[J]. Trans Am Ophthalmol Soc, 1893, 6:594.
[29] 翟生, 熊道海, 武忠炎. 切口闭合引流在髋关节置换术中作用的系统评价[J]. 现代中西医结合杂志, 2010, 19(16):1959-1962.
[30] Zhang Q, Guo W, Zhang Q, et al. Comparison between closed suction drainage and nondrainage in total knee arthroplasty:a meta-analysis[J]. J Arthroplasty, 2011, 26(8):1265-1272.
[31] Kim YH, Cho SH, Kim RS. Drainage versus nondrainage in simultaneous bilateral total hip arthroplasties[J]. J Arthroplasty, 1998, 13(2):156-161.

相关文章 15

[1]	底学敏,牛书雷,赵静,杜随,于慧敏,张宏涛,王娟. CT引导下¹²⁵I粒子植入治疗晚期胃癌淋巴结转移[J]. 山东大学学报（医学版）, 2017, 55(9): 79-84.
[2]	赵文博,甄长青,袁代,单宁宁,王娜,封丽丽,李沛沛,丁梅,李英,张凌岩,王欣. 膦甲酸钠治疗血液病患者合并EB病毒感染的临床疗效[J]. 山东大学学报（医学版）, 2017, 55(9): 96-99.
[3]	林萍珍,薛娇美,杨蓓,李萌,周麦琳,曹枫林. 基于Pearson相关系数的癌症患者创伤后成长与心理适应相关性的Meta分析[J]. 山东大学学报（医学版）, 2017, 55(9): 110-121.
[4]	焦凤萍,张海涛,赵英会,田兆菊,杨树林. 单纯疱疹病毒2型DNA疫苗在小鼠体内分布及安全性的初步分析[J]. 山东大学学报（医学版）, 2017, 55(7): 38-42.
[5]	颜进项,孟雷,董亚南,张爱军,岳洪胜,李波,钟良君,白爱国. 优化救治流程与Solitaire FR支架在治疗急性脑动脉闭塞中的应用[J]. 山东大学学报（医学版）, 2017, 55(7): 49-54.
[6]	杜金阁,陈慧,杨孝荣,吕明. STAT4 rs7574865位点单核苷酸多态性与系统性红斑狼疮易感性Meta分析[J]. 山东大学学报（医学版）, 2017, 55(5): 95-102.
[7]	王丽丽,霍彬,王磊,汪浩,侯定坤,霍小东,王金焕,臧立,曹强,柴树德,王海涛. 亚肺叶切除联合¹²⁵I粒子植入治疗早期肺癌有效性的Meta分析与系统评价[J]. 山东大学学报（医学版）, 2017, 55(10): 76-83.
[8]	刘松涛,沈斌,林辉,李香伟,温昭科. 全胸腔镜下心脏不停跳与停跳二尖瓣置换术的对比[J]. 山东大学学报（医学版）, 2016, 54(8): 39-43.
[9]	王军锋,刘倩,孙小刚,李金良,徐加龙,吕其刚,马楠,王若义. 门静脉左支血管转流术治疗小儿门静脉海绵样变性的疗效评估[J]. 山东大学学报（医学版）, 2016, 54(7): 28-32.
[10]	张斌,张良文,迟令懿,王传伟,朱树干. 显微血管减压术治疗原发性三叉神经痛疗效的相关因素[J]. 山东大学学报（医学版）, 2016, 54(6): 69-72.
[11]	木哈达斯·吐尔逊依明,帕它木·莫合买提,托兰古丽·买买提库尔班. CDKAL1(rs10946398 C/A)基因多态性与2型糖尿病易感性关系Meta分析[J]. 山东大学学报（医学版）, 2016, 54(2): 75-85.
[12]	孙祥耀,海涌,张希诺. 经皮内固定术与传统后路开放内固定术治疗胸腰椎骨折不良事件比较的Meta分析[J]. 山东大学学报（医学版）, 2016, 54(11): 56-63.
[13]	张明明,安永辉,韩彩莉,张瑛琪,马明,李娜,邹长鹏. CIK细胞联合光动力治疗中晚期食管癌的疗效观察[J]. 山东大学学报（医学版）, 2016, 54(1): 38-41.
[14]	董吴平. 单侧外固定支架结合负压封闭引流技术治疗胫腓骨GustiloⅢ型骨折的疗效[J]. 山东大学学报（医学版）, 2015, 53(9): 86-89.
[15]	苏静, 薛娇美, 孙菲菲, 郭兆新, 程翔宇, 孟力维, 刘照旭. 肾单位保留术和肾癌根治术治疗T1b期肾癌的Meta分析[J]. 山东大学学报（医学版）, 2015, 53(9): 65-70.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed