摘要目的 系统评价进行初次全膝关节置换术后引流与否对疗效的影响,评价两种不同治疗方案的差异,为临床治疗提供参考.方法 检索Cochrane图书馆、PubMed、EMBase、Springer、中国生物医学文献数据库、中国知网、维普和万方数据库,收集筛选初次行人工全膝关节置换术留置引流与否的随机对照试验,采用CONSORT的22条标准进行文献的质量评价,应用RevMan Version 5.1.6软件对数据进行统计分析,采用Cochrane协作网推荐的方法进行meta分析.结果 共纳入21个随机对照试验,纳入的研究不存在发表偏倚.合计1920例患者,其中引流组979例,非引流组941例.引流组在术后软组织瘀斑发生率低于非引流组(OR=0.30,95％ CI:0.24 ～0.49),在术后失血量(MD=320.03,95％CI:235.31 ～404.76)和输血人数(OR=1.83,95％ CI:1.26～ 3.29)上引流组高于非引流组.两组在感染(OR =0.53,95％ CI:0.22～1.32)、深静脉血栓发生率(OR=1.00,95％ CI:0.46 ～2.18)及关节术后活动度(MD=-0.04,95％CI:-1.11 ～ 1.02)等方面差异均无统计学意义.结论 基于当前证据,与不放置引流相比,留置引流并无明显优势.

abstractsObjectives To investigate the different effects of closed suction drainage and nondrainage for total knee arthroplasty (TKA) and to provide reference information for the choice of clinical treatment.Methods Randomized controlled trials (RCTs) of closed suction drainage versus non-drainage for TKA were collected from the Cochrane Library,PubMed,EMBase,Springer,CBM,CNKI,VIP and WANFANG database.Methodological quality of the RCTs was independently assessed using the Consolidated Standards of Reporting Trials (CONSORT) checklist.Data analysis was performed by RevMan Version 5.1.6 based on the methods recommended by the Cochrane Collaboration.Results Twenty-one RCTs without bias were finally enrolled,and 1920 enrolled knees were identified into drainage group (979 knees)and non-drainage group (941 knees).A lower incidence of soft tissue ecchymosis was demonstrated in the closed suction drainage group (OR =0.30,95％ CI:0.24-0.49) ; however,compared with the non-drainage group,more loss of blood (MD =320.03,95％ CI:235.31-404.76) and more need of homologous blood transfusion (OR =1.83,95％ CI:1.26-3.29) were found in the closed suction drainage group.In addition,there were no significant differences of postoperative infection (OR =0.53,95％ CI:O.22-1.32),deep venous thrombosis (OR =1.00,95％ CI:0.46-2.18),and the joint range of motion (MD =-0.04,95％ CI:-1.11-1.02) between the two groups.Conclusion Based on the current evidence,no obvious advantage is demonstrated for closed suction drainage,in comparison with non-drainage for TKA.