骨蜡在全膝关节置换术中止血作用的有效性和安全性评价

Bone wax for hemostasis in total knee arthroplasty(TKA)

[目的]探讨骨蜡减少单侧初次全膝关节置换术患者出血量的有效性及安全性。[方法]回顾性分析本院2013年1月--2013年12月收治应用骨蜡止血的行单侧初次全膝关节置换术的42例患者资料。与同期未使用骨蜡治疗的单侧初次全膝关节置换患者按1∶1配对,配对条件为诊断相同、性别相同、年龄相近（±3岁）、BMI相近（±2）、膝关节影像学相似;手术及术后处理相同。对术中失血量、术后引流量、隐性失血量、显性失血量、总失血量、输血比例、临床效果（膝关节疼痛VAS评分、关节活动度、膝关节HSS评分）及术后并发症等指标进行评估,分析骨蜡减少单侧初次全膝关节置换术患者出血量的有效性及安全性。[结果]两组病例年龄、性别、BMI、术前Hb、PLT、HSS评分、术中止血带时间、术中失血量之间差异无统计学意义（P〉0.05）。骨蜡组和对照组术后第1 d Hb分别为（109.88±10.71）g/L和（103.98±10.88）g/L、第3 d Hb分别为（94.67±8.64）g/L和（89.83±6.86）g/L,显性失血量分别为（385.71±173.04）ml和（453.93±163.39）ml、总失血量分别为（884.07±206.31）ml和（995.48±209.33）ml,其中术后24 h引流量分别为（138.10±110.74）ml和（206.31±107.64）ml。上述指标两组之间差异均有统计学意义（P〈0.05）。两组患者术后肢体肿胀、切口愈合、感染率等指标差异无统计学意义。[结论]全膝关节置换术中使用骨蜡封闭假体未覆盖截骨面及定位骨孔,可以有效减少术后出血量,而且未增加并发症的风险。

[ Objective] To evaluate the effectiveness and safety of bone wax in reducing blood loss associated with unilat- eral primary TKA. [ Methods] A retrospective study was carried out to analyze 42 patients who received unilateral primary TKA in which bone wax was used to reduce their blood loss during Jan - Dec, 2013 in our hospital. They were paired one - on - one with patients who received unilateral primary TKA during the same time period in which bone wax was not used, based on condi- tions including the same diagnosis, same gender, similar age （ ＋ 3 years）, similar BMI （＋ 2）, similar imaging changes, same intraoperative and postoperative treatments. The effectiveness and safety of bone wax in reducing blood loss in unilateral pri- mary TKA was evaluated through assessing the intraoperative blood loss, postoperative blood loss via drainage, hidden blood loss, visible blood loss, total blood loss, blood transfusion, clinical effects （VAS scores in pain, ROM and HSS scores ） , postoperative complications and other indicators. [ Results ] No difference of statistical significance （ P 〉 0. 05 ） had been shown between the two groups in terms of age, gender, BMI, preoperative Hb, PLT, HSS scores, time of using tourniquet in operation, and intraoperative blood loss. However, the group with bone wax and the control group had displayed difference of statistical significance （P 〈 0.05 ） in terms of indicators related to blood loss, with day 1 postoperation Hb [ （ 109. 88 ± 10. 71 ） g/L and （ 103.98 ± 10. 88） g/L respectively ], day 3 postoperation Hb [ （94. 67 ± 8.64） g/L and （89.83 ± 6. 86） g/L respectively], the visible blood loss [ （385.71 ± 173.04） ml and （453.93 ±163.39） ml respectively], the total blood loss [ （ 884. 07±206. 31 ） ml and （995.48± 209. 33 ） ml respectively ], and especially, the blood loss via drainage 24 hours postoperation [ （ 138. 10±110.74） ml and （206. 31 ± 107.64） ml respectively] . The two groups had displayed no difference of statistical significance in terms of other indicators including limb swelling, incision healing and infection rate. [ Conclusion] The usage of bone wax in TKA to cover positioning hole and cutting surface of bone that were not covered by prosthesis can effectivelyreduce perioperative blood loss without increasing the risk of complications.