To Explore The Effect Of Three Different Negative Pressure Interval Drainage Methods On The Early Clinical Efficacy Of TKA

Objective: To investigate and compare the early clinical effects of three different negative pressure interval drainage methods after total knee arthroplasty(TKA),and provide clinical and theoretical basis for the selection of drainage methods after total knee arthroplasty.Methods: According to the inclusion and exclusion criteria,a total of TKA was included for grade Ⅲ or Ⅳ knee osteoarthritis from September 2018 to June 2020.120 patients were treated and randomly divided into group A,group B,group C,and group D(control group)by random number table method,with 30 cases in each group.All patients underwent closed drainage after TKA and clamped the tube for 6 hours.After that,group A,group B,and group C adopted drainage methods to maintain drainage negative pressure values of(470,735]mm Hg,(205,470]mm Hg,(0,205]mm Hg,respectively,in three different negative pressure intervals,group D Adopt normal pressure drainage for non-negative pressure drainage,pull out the drainage tube when the drainage flow is less than 50 ml in 24 h or drain to 48 h.Observe and record the operation.After 6-8h,8-16 h,16-24 h and extubation,the total blood loss,hidden blood loss,blood transfusion,joint function,pain,swelling and other indicators of the four groups of patients within 72 hours after the operation were compared at the same time,Using SPSS 18.0 software to perform statistical analysis on the corresponding indicators of each group.Results: The total drainage volume of patients in groups A,B,C,and D was374.23±70.95 ml,295.53±69.24 ml,233.67±64.13 ml,192.37±51.06 ml,respectively.Group A was significantly higher than that of B,C,and D.Group B was significantly higher than group C and group D(P<0.05),but there was no significant difference between group C and D(P>0.05).Postoperative extubation time in groups A,B,C,and D was 39.67±3.79 h,36.78±5.24 h,33.64±4.56 h,42.77±3.47 h,group D was significantly longer than group A,B,C(P< 0.05),while the extubation time of group C was the shortest(P<0.05).The total blood loss in the four groups A,B,C,and D at72 hours after the operation was 1107.14±100.65 ml,902.65±138.15 ml,658.04±104.74 ml,531.35±80.83 ml,among which group A was significantly higher than the three groups B,C,and D,Group B was significantly higher than group C and group D(P<0.05),but the difference between the two groups C and D was not significant(P>0.05).the blood transfusion volume and blood transfusion rate of the four groups were not significantly different(P> 0.05).The difference in the circumference of the knee joint of the four groups of patients was significantly greater than that of the three groups A,B,and C at 24 h,extubation,and 72 h after the operation(P<0.05).Comparison between the three groups of A,B,and C There was no significant difference(P>0.05).The pain VAS scores of the four groups at 8h,12 h,and 24 h after the operation were significantly higher in group A and group D than in group B or C(P<0.05).The maximum knee flexion angle of the four groups of patients on the second and third day after operation and the active maximum knee flexion angle on the second,third and fourth day after operation in group D were significantly smaller than those in groups A,B,and C(P<0.05),while A,There was no significant difference between the three groups of B and C(P>0.05).There was no significant difference in the incidence of postoperative infection,death and other complications among the four groups(P>0.05).Conclusion:4.1 Interval drainage with negative pressure values of(470,735] mm Hg and(205,470]mm Hg increased the drainage and blood loss after TKA to a certain extent,but did not increase the blood transfusion rate and blood transfusion;compared with other groups,the negative pressure value The interval drainage of(0,205] mm Hg can ensure effective drainage while not increasing the amount of drainage,blood loss and blood transfusion after TKA.4.2 Appropriate negative pressure interval drainage can significantly reduce the time of extubation after TKA,increase drainage efficiency,reduce the incidence of pain,swelling,joint dysfunction and other complications.Therefore,it can help patients with early postoperative functional exercises,and promote rapid postoperative recovery(ERAS)to improve clinical efficacy.