反向肩关节置换术可避免使用引流管。

Injury Pub Date : 2023-12-01 Epub Date: 2024-01-13 DOI:10.1016/j.injury.2023.111041
Beatriz Garcia-Maya, Sara Morais, Jesus Diez-Sebastian, Samuel Antuña, Raul Barco
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引用次数: 0

摘要

背景:引流管在髋关节和膝关节置换术中没有明显的益处,还可能产生一些有害影响。而在肩关节置换术中使用引流管的效果却鲜有证据。我们假设使用引流管会增加术后失血,但不会减少伤口并发症:我们纳入了103例反肩关节置换术(RSA),其中71例因退行性病变而手术,32例因骨折而手术。所有并发症均记录在案。收集血红蛋白(Hb)和血细胞比容(Htc)水平,并与术后数据进行比较。此外,还记录了住院时间和排泄量:结果:45 名患者接受了闭式抽吸引流术。结果:45 名患者接受了闭式抽吸引流术,凝血功能障碍患者的出血量明显增加,因此被排除在外(p = 0.03)。因骨折而接受手术的患者年龄更大(80.1 岁对 72.1 岁):使用和未使用引流管的患者并发症发生率相似。肩关节置换术后使用引流管不会影响术后出血,但会增加住院时间。引流管似乎是RSA术后不必要的干预措施,可能会增加相关费用,可以放心放弃:III级回顾性比较研究。
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Drain use can be avoided in reverse shoulder arthroplasty.

Background: Drains have demonstrated no clear benefits and some potentially harmful effects in hip and knee replacements. There is little evidence about the effects of its use in shoulder arthroplasty. We hypothesized that drain use would increase postoperative blood loss without reducing wound complications.

Methods: We included 103 reverse shoulder arthroplasties (RSA), 71 were operated for degenerative pathology, 32 due to a fracture. All complications were recorded. Hemoglobin (Hb) and hematocrit (Htc.) level were collected and compared to postoperative data. Length of hospitalization and volume output were also noted.

Results: 45 patients received a closed-suction drain. Patients with coagulopathy had significant higher bleeding and were excluded (p = 0.03). Patients operated for a fracture were older (80.1y.o vs 72.1 p < 0.01) and had higher blood drop (∆Hb p = 0.01; ∆Htc p = 0.03). There were neither differences between drain and control group in ∆Hb or ∆Htc in the degenerative RSA group (1.84+/-0.89 vs 1.68+/-0.84, p = 0.36; 5.78+/-2.89 vs 5.53+/-2.87 p = 0.50) nor in the fracture RSA group (2.65+/-0.94 vs 2.65+/-1.01, p = 0.90; 7.91+/-2.99 vs. 7.09+/-4.21, p = 0.56). There were neither differences in complications (degenerative p = 0.33; fracture p = 0.21). Drain use was related to a longer hospital stay in elective surgery (2.6 vs 1.8 days; p < 0.01).

Discussion: The rate of complication is similar between patients with and without drain use. Drain use after shoulder arthroplasty does not affect postoperative bleeding but increases the length of hospital stay. Drains seems to be an unnecessary intervention after RSA that may increase associated costs and can be safely abandoned.

Level of evidence: Level III retrospective comparative study.

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