氨甲环酸关节腔内注射联合置换后3h夹闭引流管对膝关节单髁置换失血量的影响

Effects of intraarticular tranexamic acid injection combined with 3-hour drainage tube occlusion postoperatively on blood loss in unicompartmental knee arthroplasty

背景:单髁置换已经成为治疗膝关节单间室骨性关节炎的主流术式,但仍然存在出血过多导致置换后输血的问题,从而增加输血率、住院费用及输血并发症,而氨甲环酸用于全膝关节置换取得了良好的效果,研究局部应用氨甲环酸能否有效减少单髁置换中的出血量意义重大。目的:探究氨甲环酸关节腔内注射在膝关节内侧间室单髁置换中减少围手术期失血的安全性及有效性。方法:选择2014年1月至2015年8月大连医科大学附属二院关节外科收治行单侧膝关节内侧间室单髁表面置换的膝骨关节炎患者共122例,随机分为2组,氨甲环酸组关节表面置换完成松止血带前从引流管向关节腔内注入氨甲环酸10 m L(含1 000 mg)+氯化钠注射液10 m L,对照组同期关节腔内注入氯化钠注射液20 m L,2组均在注射后夹闭引流管3 h,置换后48 h拔出引流管。对比分析2组患者置换后2 d及1个月血红蛋白水平和红细胞压积、置换后2 d总失血量和引流量、置换后输血人数、置换后1周及1个月膝关节功能美国特种外科医院评分、置换后1周有无双下肢深静脉血栓形成等指标,评估氨甲环酸对膝关节单髁置换失血量的影响。结果与结论:1氨甲环酸组置换后2 d血红蛋白、红细胞压积值均显著高于对照组(P<0.05);置换后1个月2组血红蛋白及红细胞压积值比较差异无显著性意义(P>0.05);2氨甲环酸组置换后2 d引流量及总失血量较对照组显著减少(P<0.05);3氨甲环酸组输血人数(0例)较对照组输血人数(6例)明显减少,差异有显著性意义(P<0.05);4置换后1周膝关节美国特种外科医院评分氨甲环酸组较对照组增高(P<0.05);置换后1个月2组美国特种外科医院评分比较差异无显著性意义;5置换后1周2组患肢静脉彩超未见静脉血栓形成;6提示在膝关节内侧间室单髁表面置换过程中,氨甲环酸关节腔内注射联合置换后3 h夹闭引流管能够显著减少引流量及围手术期出血量,降低输血率,并且有利于置换后患者膝关节功能早期恢复,不增加双下肢深静脉血栓形成的风险。

BACKGROUND：Unicompartmental knee arthroplasty has become mainstream operation for treatment of unicompartmental osteoarthritis of the knee,but unicompartmental knee arthroplasty still has some problems,such as excessive bleeding-induced postoperative blood transfusion,increased blood transfusion rate,hospitalization expense and complication of blood transfusion.As tranexamic acid for total knee arthroplasty has achieved good effects.It is significant to investigate whether local application of tranexamic acid can effectively reduce blood loss in unicompartmental arthroplasty.OBJECTIVE：To investigate the efficacy and safety of the intra-articular tranexamic acid injection in treating perioperative blood loss in patients undergoing unicompartmental knee arthroplasty.METHODS：122 patients with knee osteoarthritis undergoing unicompartmental knee arthroplasty in the Department of Orthopedics,the Second Affiliated Hospital of Dalian Medical University from January 2014 to August 2015 were enrolled in this study.All patients were randomly divided into two groups.Patients in the tranexamic acid group were injected with 10 m L of tranexamic acid（containing 1 000 mg） ＋ 10 m L of sodium chloride injection in the articular cavity before loosening the tourniquet.Patients in the control group received 20 m L of sodium chloride injection in the articular cavity.In both groups,the drainage tube was clipped for 3 hours after injection.At 48 hours after replacement,the drainage tube was pulled out.We compared and analyzed hemoglobin levels and hematocrit at 2 days and 1 month postoperatively,total blood loss and drainage volume at 2 days postoperatively,the number of patients receiving blood transfusion,Hospital for Special Surgery scores of knee function at 1 week and 1 month postoperatively,and thrombosis at 1 week postoperatively,and evaluated effects of tranexamic acid on blood loss after unicompartmental knee arthroplasty.RESULTS AND CONCLUSION：（1） Hemoglobin levels and hematocrit were significantly higher in the tranexamic acid group than in the control group at 2 days postoperatively（P〈0.05）.No significant difference in hemoglobin levels and hematocrit was detected at 1 month postoperatively in both groups（P〉0.05）.（2） Drainage volume and total blood loss were significantly less in the tranexamic acid group than in the control group at 2 days postoperatively（P〈0.05）.（3） The number of patients receiving blood transfusion was significantly less in the tranexamic acid group（0 case） than in the control group（6 cases）（P〈0.05）.（4） Scores of Hospital for Special Surgery were significantly higher in the tranexamic acid group than in the control group at 1 week postoperatively（P〈0.05）.No significant difference in above socres was identified between the two groups at 1 month postoperatively.（5） No venous thrombosis was found at 1 week postoperatively in both groups.（6） These results confirm that during knee medial unicompartmental arthroplasty,intra-articular injection of tranexamic acid combined with 3 hours of blood occlusion can effectively reduce drainage volume,perioperative blood loss,blood transfusion,is beneficial to the early recovery of knee joint function after replacement,and does not increase the risk of lower extremity deep venous thrombosis.