人工全髋关节置换术后负压引流的临床对照研究

Clinical Controlled Study on Negative Pressure Drainage after Total Hip Arthroplasty

摘要: 背景：随着人口老龄化加速及生活方式的改变，股骨头坏死(药物性、酒精性、创伤性)、股骨颈骨折、髋骨关节炎疾病日益增多。人工全髋关节置换术(Total Hip Arthroplasty, THA)作为此类疾病的主要治疗方式，需求随之增大，THA不仅可以显著缓解疼痛、有效恢复关节活动度及功能，还能够帮助患者早期离床活动，同时降低褥疮、下肢静脉血栓等长期卧床并发症的发生概率。然而，THA存在一些术后并发症，如疼痛、感染、假体松动及周围骨折、神经血管损伤等，其中感染是最严重的并发症之一。目的：探讨THA术后24小时关节囊内安置负压引流器对患者白细胞、红细胞沉降率、C反应蛋白、血红蛋白的影响。方法：对2020年6月至2024年8月在我科行全髋关节置换术的患者进行回顾性分析，严格按照纳入标准和排除标准入选52例患者，收集两组患者的一般资料、术后第1、3、5、7、10天的WBC、CRP和ESR 水平，并进行统计学分析。结果：两组患者性别、身高、体重、年龄、疾病种类、手术部位等基础资料无显著差异，两组患者手术顺利，均无严重并发症发生。引流组与非引流组术后不同时间点(术后第1、3、5、7、10天)里WBC水平在引流组与非引流组之间均不存在显著的差异，P > 0.05水平。通过两组结果对比检验得出术后1天以及术后7天CRP水平在引流组与非引流组之间存在显著的差异，P < 0.05水平，具体表现为引流组CRP显著更高；而术后3、5、10天CRP水平在引流组与非引流组之间不存在显著的差异，P > 0.05水平。术后不同时间点ESR水平在引流组与非引流组之间不存在显著的差异，P > 0.05水平。结论：人工全髋关节置换术后采取切口引流会在术后使CRP水平升高，增加术后感染的风险，但严格控制术后引流放置时间配合术后抗生素治疗可以有效降低炎症反应的程度。

Abstract: Background: With the acceleration of population aging and changes in lifestyle, diseases such as femoral head necrosis (drug-induced, alcohol-induced, and traumatic), femoral neck fractures, and hip osteoarthritis are increasing. Total Hip Arthroplasty (THA) is the main treatment for these diseases, and the demand for it is increasing. THA can significantly relieve pain, effectively restore joint range of motion and function, and help patients get out of bed early, while reducing the occurrence of long-term bedridden complications such as pressure sores and deep vein thrombosis of the lower extremities. However, THA has some postoperative complications, such as pain, infection, prosthesis loosening, surrounding fractures, and nerve and vascular injuries. Among them, infection is one of the most serious complications. Objective: To explore the effect of placing a negative pressure drainage device in the joint capsule 24 hours after THA on the levels of white blood cells (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and hemoglobin (HB) in patients. Methods: A retrospective analysis was conducted on patients who underwent total hip arthroplasty in our department from June 2020 to August 2024. Fifty-two patients were selected strictly according to the inclusion and exclusion criteria. General data of the two groups of patients and the levels of WBC, CRP, and ESR on the 1st, 3rd, 5th, 7th, and 10th days after surgery were collected and statistically analyzed. Results: There were no significant differences in basic data such as gender, height, weight, age, disease type, and surgical site between the two groups. The surgeries of both groups were successful, and no serious complications occurred. There were no significant differences in WBC levels between the drainage group and the non-drainage group at different time points after surgery (1st, 3rd, 5th, 7th, and 10th days), P > 0.05. The comparison of the results of the two groups showed that there were significant differences in CRP levels between the drainage group and the non-drainage group on the 1st and 7th days after surgery, P < 0.05, with significantly higher CRP levels in the drainage group. There were no significant differences in CRP levels between the two groups on the 3rd, 5th, and 10th days after surgery, P > 0.05. There were significant differences in ESR levels between the drainage group and the non-drainage group at different time points after surgery, P < 0.05, with significantly higher ESR levels in the drainage group. There were no significant differences in ESR scores between the two groups at other time points, P > 0.05. Conclusion: Postoperative incision drainage after total hip arthroplasty can increase CRP levels and increase the risk of postoperative infection. However, strictly controlling the placement time of postoperative drainage and combining it with postoperative antibiotic treatment can effectively reduce the degree of inflammatory response.