A Randomized Controlled Study Of The Impact Of Hidden Blood Loss And Rehabilitation Exercises In Different Treatment Of Postoperative Drainage After Unilateral Total Knee Arthroplasty

ObjectiveA prospective Comparison of placed closed drainage (no clamping group,4hclamping group,6h clamping group) and not placed the closed drainage in hidden bloodloss and the impact of postoperative functional rehabilitation exercise after Unilateral totalknee arthroplasty, to analyze and discuss the impact of hidden blood loss andrehabilitation exercises in different treatment of postoperative drainage, so choose the bestmeasures to guide clinical work.MethodProspective study was conducted between September2011and February2013,112cases of unilateral total knee arthroplasty in our hospital were prospectively randomizedinto placed the closed drainage (no clamping group,4h clamping group,6h clampinggroup) and not placed the closed drainage group, All patients completed the operation bythe same group of physicians, who had no history of knee surgery, are the first line of kneereplacement surgery, are using continuous epidural anesthesia, using the same surgicaloperation, smooth intraoperative and postoperative blood pressure. According to height,weight, hematocrit before and after surgery (Hct), and blood transfusion,the total bloodloss after surgery was calculated by Gross formula, comparing four groups of the drainagevolume in48h after surgery respectively,and then calculate the amount of hidden bloodloss, and measured the pain of knee jiont by VAS score for patients after2days,7days,two weeks and evaluated the knee jiont function by HSS score system after12months. Alldata were processed by SPSS19.0, all the measurement data with the mean±standarddeviation (x±s) said and the comparison between multiple samples using one-way ANOVA analysis of variance,between the two groups by the t test. Enumeration data using a list ofdata rows x chi-square test, P <0.05was considered statistically significant.ResultsWe found no statistically significant differences in terms of demographic data amongthe four groups. The total blood loss of the closed drainage group was significantly morethan that of the unused closed drainage group in the patients of Unilateral total kneereplacement surgery (P=<0.05); The total drainage volume of early clamping group (4hgroup and6h group) was significantly lower than no clamping group (P <0.01); Thehidden blood loss of6h clamping group was significantly lower than not placed the closeddrainage group and no clamping group (P <0.01); The hidden blood loss of4h clampinggroup were no different than6h clamping group (P>0.05); VAS scores increasedsignificantly (P <0.01) in the unused closed drainage group compared with the used closeddrainage group in the2d,7d, and two weeks; In the used closed drainage group, VASscores of the no clamping group decreased significantly compared with the early clampinggroup (4h group and6h group) in the2d and7d (P <0.01), The VAS scores between4hgroup and6h group were no significant difference (P>0.05). After two weeks, the VASscores between both of the three groups were not significantly different (P>0.05). Nodifferences in postoperative complications and knee function score were recorded betweenthe four groups(P>0.05).ConclusionEarly clamping drainage can significantly reduce blood loss after total kneearthroplasty without increasing the associated postoperative complications, decrease thepain,achieve more satisfactory early functional recovery than patients who unused closeddrainage group; the amount of hidden blood and total blood loss in6h clamping group wasless than the group who was no clamping or clamping4h, so delaying release of the drainsby six hours is recommended. Therefore, after TKA conventional clamping drainage sixhours is a simple method, clinical effect is good, has a certain value.