关节腔内注射氨甲环酸对单侧人工全膝关节置换术后引流量的影响

Effect of intra-articular tranexamic acid injection on postoperative drainage volume after unilateral total knee arthroplasty

目的探讨关节腔内注射氨甲环酸对初次单侧人工膝关节置换(TKA)术后引流量的影响。方法回顾性分析自2013-01—2014-08进行的88例初次单侧TKA,其中实验组44例采用关节腔内注射氨甲环酸止血,未使用氨甲环酸的44例作为对照组。记录术中出血量、术后引流量,以及术后24、72 h血红蛋白(Hb)、红细胞压积(Hct)、D-二聚体。观察是否存在下肢深静脉形成(DVT)等并发症。结果对照组4例术后予输注异体悬浮红细胞以纠正贫血,试验组与对照组各1例出现局部切口愈合不良,其余切口均一期愈合。所有患者术后均未发生急性假体周围感染,且未出现下肢DVT或肺栓塞及其他严重内外科并发症发生。2组术中出血量差异无统计学意义(P>0.05)。试验组术后24 h及总引流量均明显少于对照组,差异有统计学意义(P<0.05)。试验组术后72 h Hb、Hct较术前变化幅度小于对照组,差异有统计学意义(P<0.05)。2组手术前后D-二聚体的变化幅度差异无统计学意义(P>0.05)。结论初次单侧TKA术中关节腔内注射氨甲环酸能明显减少术后引流量,从而降低患者围手术期的贫血相关并发症的风险,降低输血率,提早进行膝关节功能锻炼,并不增加下肢DVT发生的风险。

Objective To evaluate the effect of intra-articular tranexamic acid injection on the postoperative drainage volume after total knee arthroplasty（TKA）. Methods The postoperative drainage volume after total knee arthroplasty（TKA） in 88 cases from Jan. 2013 to Aug. 2014 was retrospectively analyzed. The 88 cases were randomly divided into experimental group and control group.The experimental group included 44 patients who had intra-articular tranexamic acid injection during the operation to stop bleeding, while the control group included the other 44 patients. The volume of intraoperative blood loss,postoperative drainage, hemoglobin, red blood cells deposited, D-dimer and related blood coagulation index before and 24 hours and 72 hours after operation were recorded. The presence of lower extremity deep venous thrombosis（DVT） as well as other complications was evaluated. Results Four cases in the control group were infused with suspended red blood cells after operation to treat anaemia. One case each in both groups had abnormal healing of part incision, others were healed with first intention. All the cases did not have acute infection around the prosthesis, lower extremity deep venous thrombosis, pulmonary embolism or other severe complications. There was no statistically significant difference in bleeding amount between 2 groups（P 〉0.05）. The total drainage volumein 24 hours after operation in the experimental group was significantly less than the control group, the difference was statistically significant（P 〈0.05）. The extent of change in Hb and Hct in 72 hours after operation in the experimental group was less than the control group, variations in the preoperative difference was statistically significant. There was no statistical significant difference in the extent of change of D-dimer after operation betweentwo groups（P 〉0.05）. Conclusion Intra-articular tranexamic acid injection significantly reduces postoperative drainage volume after total knee arthroplasty, and thereby reduces the risk of anemia related complications and the rate of blood transfusion.