微孔多聚糖止血球在全膝关节置换中止血效果的观察

Microporous polysaccharide hemospheres as hemostatic agents in total knee arthroplasty： a prospective randomized study

目的评价全膝关节置换术中关节腔内局部使用微孔多聚糖止血球的安全性和止血效果。方法将80例2006年7月至2007年7月行单侧全膝关节置换术的骨关节炎患者随机分为两组，每组40例：试验组于术中关节囊内局部喷撒微孔多聚糖止血球（MPH）进行止血，对照组不喷撒MPH。记录术中引流量，常规放置引流，计算显性失血量，并按Gross推荐的公式计算术后隐性失血量。比较两组患者显性和隐性失血量、血红蛋白下降值、输血量、主动直腿抬高时间、膝关节屈曲至90°时间、主动活动度以及深静脉血栓形成和切口并发症的发生情况。结果关节腔内局部使用MPH后，试验组显性和隐性失血量，血红蛋白的丢失，输血量均显著少于对照组，差异有统计学意义（P〈0．05）。膝关节主动活动达90°的时间以及术后15d内主动活动度方面，试验组均优于对照组。在深静脉血栓及术后切口并发症的比较上，试验组有2例切口愈合不良和6例深静脉血栓形成，对照组有2例切口愈合不良和7例深静脉血栓形成，两组差异无统计学意义（P〉0．05）。结论全膝关节置换术中关节腔内局部使用MPH止血有助于减少失血量和输血量，有助于早期康复训练，且无明显副作用，具有操作简单、安全、有效的优点。

Objective To evaluate the safety and efficacy of microporous polysaccharide hemispheres （MPH） in controlling blood loss in total knee arthroplasty （TKA）. Methods A total of 80 patients with osteoarthritis who would undergo unilateral TKA were randomized prospectively into 2 equal groups. In trial group, during TKA, MPH was sprayed into the capsule and on the muscle and tendons to control bleeding. In control group, patients did not receive MPH. The blood loss （overt and occult）, postoperative decrease in hemoglobin, volume of blood transfusion, time for active straight-leg raising, time for 90-degree knee flexion, range of active motion, deep vein thrombosis （DVT） and incision complications were recorded and compared between the 2 groups. Results The overt and occult blood loss and postoperative decrease in hemoglobin were lower in the trial group than in the control group. The trial group required less blood transfusion than the control group. In the range of active motion on the 7th, 15th and 19th days postoperatively, the trial group was better. In the trial group, 2 patients had wound effusion and 6 had DVT; in the control group, 2 patients had wound effusion and 7 had DVT. The differences were insignificant. Conclusion Intraoperative MPH usage is safe and effective in controlling intra- and postoperative bleeding.