The Clinical Effect Of Two Drainage Methods In Primary Total Hip Replacement

Background:Total hip arthroplasty（THA）is one of the hip reconstruction procedure which has been extensively developed.In addition to the postoperative operation technology of hip joint,the occurrence of perioperative bleeding and postoperative complications is a key and difficult problem for clinicians.Postoperative drainage is wide ly used in surgery,which is helpful to reduce postoperative local swelling,accelerate incision healing and reduce postoperative infection and other complications.There are disputes in academic circles about whether conventional drainage is needed after the primary THA.The disputes mainly focus on whether drainage is needed,drainage pressure and drainage process treatment,etc.It is suggested that strict perioperative management,especially under the condition of standardized implementation of bleeding control and infection prevention measures,without drainage after THA,can reduce blood loss and increase the incidence of complications.However,at the same time,there are still studies that do not place drainage can not reduce blood loss,and may even increase the incidence of complications such as infection,which is not conducive to the recovery of joint function.So far no drainage after operation is a relatively cutting-edge research direction,which is affirmed by some scholars.At present,closed negative pressure drainage（CSD）is still recommended in orthopedic surgery.Intra capsule drainage belongs to the traditional drainage method.Without drainage after the primary THA operation,the bleeding around the capsule can not be led out,which is not conducive to the recovery of patients after surgery.In theory,external capsule drainage is helpful to improve the above situation.However,there is no report on the location of drainage tube after the primary THA.The placement of CSD after the primary THA can be divided into two types:intraarticular and extraarticular.Therefore,the clinical effects of two kinds of CSD placement after the primary THA were analyzed and compared,and the characteristics of the two drainage methods were discussed.Objective:To explore the influence of two kinds of negative pressure drainage on blood loss,leukocyte,erythrocyte sedimentation rate and C-reactive protein in patients with primary total hip replacement;Method:From March 2014 to May 2019,234 patients who underwent the primary total hip replacement in our department were analyzed retrospectively.Patients were divided into two groups:94 patients in the intra capsule group（the drainage tube was placed in the joint capsule）and 140 patients in the extracapsular group（the joint capsule was sutured and the drainage tube was placed outside the joint capsule）.The general information and operation of the two groups were collected preoperatively including Blood routine,CRP,ESR,intraoperative blood loss,blood routine on the first and third days after operation,CRP and ESR levels on the third day after operation,postoperative drainage,local infection,hematoma formation and blood transfusion.According to the collected data,the total blood loss and recessive blood loss of the two groups were calculated and statistically analyzed.Result:There was no significant difference between the two groups in gender,height,weight,age,intraoperative bleeding volume,preoperative Hb level,preoperative RBC count,preoperative WBC count,disease type,BMI stratification,surgical site and other basic data（P>0.05）,There were no cases of blood transfusion,no serious complications such as blood vessel and nerve injury;The patients in the two groups were operated successfully without blood transfusion and serious complications such as blood vessel and nerve injury during operation.There were no cases of dislocation,local infection and hematoma formation after operation in both groups.In the intracapsular group,th e total blood loss was 536.25±270.18ml on the first day after operation,727.78±300.11ml on the third day after operation,the postoperative drainage volume was 298.03±147.17ml,the dominant blood loss was 462.18±158.53ml,the occult blood loss was 265.60±333.90ml.In the extracapsular group,after operation the total blood loss was 383.72±349.04ml on the first day,654.76±302.39ml on the third day,the postoperative drainage volume was12.11±15.45ml,the dominant blood loss was 158.90±116.10ml,the occult blood loss was495.86±307.88ml.The total blood loss on the first day,the induced blood flow and the dominant blood loss were significantly higher in the intracapsular group than in the extracapsular group,and the recessive blood loss was significantly lower than that in the extracapsular group（P<0.05）.The total blood loss on the third day in the intracapsular group was higher,whereas no a significant difference（P>0.05）.In the intracapsular group,the RBC count of the patients was（4.39±0.53）×1012/L before operation,and after operation that was（3.67±0.54）×10¹²/L on the first day,（3.43±0.52）×10¹²/L on the third day;the Hb level was 132.72±14.33g/L before operation,and after operation that was110.68±15.01g/L on the first day,103.56±14.37g/L on the third day.In the extracapsular group,the RBC count of the patients was（4.53±0.48）×10¹²/L before operation,and after operation that was（3.96±0.53）×10¹²/L on the first day,（3.61±0.51）×10¹²/L on the third day;the Hb level was 132.60±15.96g/L before operation,and after operation that was116.67±16.45g/L on the first day,106.14±15.87g/L on the third day.Both the RBC count and the Hb level of patients in the intracapsular group were lower than those in the extracapsular group,the difference of the RBC count was statistically significant（P<0.05）,but there was no significant difference in Hb level（P>0.05）.The postoperative time of patients also has an impact,the RBC count and Hb level of the two groups decreased with time,and there were significant differences between the two groups at different time points（P<0.05）.There was interaction effect between placements sites and postoperative time,with the extension of postoperative time,the RBC count and the Hb level decreased differently in the two groups,with the largest decrease in the intracapsular group.In the intracapsular group,before operation,the WBC count of the patients was（6.07±1.61）×10⁹/L,the CRP level was 5.69±6.90mg/L,the ESR level was20.32±16.12mm/h,the WBC count on the first day after operation was（7.77±2.23）×10⁹/L,and on the third day after operation,the WBC count was（6.76±1.88）×10⁹/L,the CRP level was 47.53±34.44mg/L,the ESR level was 33.79±17.42mm/h.In the extracapsular group,before operation,the WBC count of the patients was（6.24±1.69）×10⁹/L,the CRP level was7.19±12.56mg/L,the ESR level was 20.22±17.51mm/h,the WBC count on the first day after operation was（9.64±2.70）×10⁹/L,and on the third day after operation,the WBC count was（7.24±1.88）×10⁹/L,the CRP level was 91.33±39.43 mg/L,the ESR level was44.97±17.79mm/h.The WBC count of patients in the intracapsular group was lower than that in the extracapsular group（P<0.05）,the postoperative time of patients also has an impact,the WBC count of the two groups increased after operation,and there was significant difference between the two groups at different time points（P<0.05）,it was the highest on the first day after operation,and then began to decline.There was interaction between placements sites and postoperative time,with the prolongation of postoperative time,the WBC count in the two groups increased differently,especially in the extracapsular group.Regardless of no a significant difference before operation in the levels of CRP and ESR between the two groups（P>0.05）.On the third day after operation,the CRP level and ESR level of the two groups were significantly higher than that before operation,th e difference was statistically significant（P<0.05）,and the levels of CRP and ESR in the intracapsular group were significantly lower than those in the extracapsular group（P<0.05）.Conclusion:（1）When the joint capsule was sutured and the drainage tube w as placed outside the joint capsule,the hidden blood loss increased and the total blood loss decreased;（2）Compared with the conventional intra-articular drainage,the level of inflammatory index increased within 3 days after operation;（3）Suture the capsule and place the drainage tube outside the capsule,compared with the conventional intra capsule drainage,it does not increase the postoperative complications.