Early Efficacies of Drainage in Arthroscopic Reconstruction with Anterior Cruciate Ligament Reconstruction
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摘要:
目的 探究关节镜自体腘绳肌腱重建前交叉韧带术后，不放引流是否会对临床疗效造成影响。 方法 2022年3月至2023年6月，59名在临沧市人民医院行关节镜自体腘绳肌腱重建前交叉韧带术的患者，随机分为不使用引流组29例（观察组），使用引流24 h组30例（对照组）。记录2组患者术后第1、3、7、14、30天疼痛情况（采用视觉模拟量表），膝关节活动度，住院时间，术后并发症发生情况；测量术前及术后大腿周径，计算出差值。 结果 经重复测量资料的方差分析，疼痛评分、大腿周径和膝关节活动度主体内效应差异均有统计学意义（P < 0.05），主体间效应差异均无统计学意义（P > 0.05）。经两独立样本t检验：术后第1天，观察组疼痛评分低于对照组（P < 0.001），大腿周径、膝关节活动度高于对照组（P < 0.05）。其余随访时间2组患者疼痛评分、膝关节活动度、大腿周径比较，差异均无统计学意义（P > 0.05）；观察组住院时间少于对照组（P < 0.001）；2组患者均无下肢神经损伤、深静脉血栓、膝关节感染、需要穿刺和抽吸的血肿等并发症。 结论 关节镜自体腘绳肌腱重建前交叉韧带术后，不放引流在术后早期对患者疼痛、膝关节活动度、大腿周径等临床疗效没有影响。且不放引流减少患者术后第1天的疼痛程度，改善膝关节活动度，减少住院天数。因此，在关节镜自体腘绳肌腱重建前交叉韧带术后，不建议常规预防性使用引流。 Abstract:Objective To investigate the impact of not using drainage on clinical outcomes after arthroscopic autologous semitendinosus tendon reconstruction with anterior cruciate ligament reconstruction. Methods From March 2022 to June 2023, 59 patients undergoing arthroscopic autologous semitendinosus tendon reconstruction with anterior cruciate ligament reconstruction in Lincang People's Hospital were collected and randomly divided into the non-drainage group consisting of 29 cases（observation group） and the 24-hour drainage group consisting of 30 cases（control group）. The pain levels of the two groups of patients were recorded on the 1st, 3rd, 7th, 14th, and 30th day after the surgery by using a visual analog scale. Additionally, the knee joint range of motion, length of hospital stay, and occurrence of postoperative complications were monitored. The circumference of the thigh was measured before and after the surgery, and the difference was calculated. Results Repeated measures analysis of variance revealed that there were statistically significant within-subject differences in pain ratings, thigh circumference, and knee joint range of motion（P < 0.05）, but no statistically significant between-subject differences（P > 0.05）. Independent samples t-tests showed that on the first day after the surgery, the observation group had lower pain ratings（P < 0.001）, and higher thigh circumference and knee joint range of motion compared to the control group（P < 0.05）. There were no statistically significant differences in pain ratings, knee joint range of motion, and thigh circumference between the two groups at the remaining follow-up times（P > 0.05）; The observation group had a shorter hospital stay than the control group（P < 0.001）; Both groups of patients had no complications such as lower limb nerve damage, deep vein thrombosis, knee joint infection, or hematomas requiring puncture and aspiration. Conclusion In the early postoperative period following arthroscopic autologous hamstring tendon reconstruction of the anterior cruciate ligament, the omission of drainage does not affect the clinical outcomes in terms of pain, knee joint mobility, and thigh circumference. Moreover, omitting drainage reduces the level of pain experienced by patients on the first day after the surgery, improves the knee joint mobility, and decreases the length of hospital stay. Therefore, in arthroscopic autologous hamstring tendon reconstruction of the anterior cruciate ligament, it is not recommended to routinely use drainage for preventive purposes. -
Key words:
- Anterior cruciate ligament reconstruction /
- Drainage /
- Hamstring tendon
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表 1 术前一般资料比较 （$ \bar x \pm s $）
Table 1. Comparison of the general information before the operation between the two groups （$ \bar x \pm s $）
项目 对照组 观察组 t/χ2 P 性别 0.007 0.779 男 22 20 女 8 9 年龄（岁） 26.53±5.99 24.72±6.68 −1.097 0.277 损伤时间（d） 40.83±12.09 43.28±20.23 0.565 0.574 体重指数（kg/m2） 24.57±2.57 23.38±2.13 −1.930 0.059 
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表 2 2组VAS评分、关节活动度、大腿周径的比较 （$ \bar x \pm s $）
Table 2. Comparison of two groups in terms of VAS scores，joint range of motion，and thigh circumference （$ \bar x \pm s $）
组别 术后1 d 术后3 d 术后7 d 术后14 d 术后30 d F P VAS评分（分） 对照组 4.55±0.58* 3.49±0.58 3.03±0.54 2.09±0.73 1.56±0.49 1052.358 <0.001* 观察组 3.84±0.71 3.70±0.61 3.17±0.26 2.28±0.85 1.41±0.20 0.681 0.413 t 4.200 −1.377 −1.264 −0.948 1.568 P <0.001* 0.174 0.213 0.347 0.122 关节活动度（°） 对照组 35.83±8.42* 48.33±7.35 51.67±9.22 70.83±14.74 6.22±6.21 158.233 <0.001* 观察组 41.03±8.28 46.55±5.19 54.31±6.23 72.93±14.24 85.34±5.50 1.163 0.285 t −2.392 1.072 −1.286 −0.556 −0.879 P 0.020* 0.288 0.204 0.581 0.383 大腿周径（cm） 对照组 1.51±0.47* 1.35±0.47 0.88±0.61 0.48±0.63 0.34±0.56 1169.869 <0.001* 观察组 1.80±0.46 1.40±0.39 0.96±0.61 0.47±0.72 0.44±0.62 3.163 0.081 t −2.397 −0.443 −0.452 0.062 −0.635 P 0.020* 0.659 0.653 0.951 0.528 与观察组比较，*P<0.05。
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表 3 2组住院时间比较[（$ \bar x \pm s $），d]
Table 3. Comparison of hospitalization time between two groups [（$ \bar x \pm s $），d]
时间 对照组 观察组 t P 住院时间 6.23±1.17 4.97±1.24 −4.051 <0.001* *P<0.001。
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