关节腔灌注氨甲环酸对关节置换术后失血膝关节功能恢复的影响

Effect of intra - articular injection of tranexamic acid on the effectiveness and safety after blood loss and functional recovery of knee joint arthroplasty

目的观察膝关节腔灌注氨甲环酸（TXA）联合引流管夹闭3 h对人工全膝关节置换术（TKA）后失血及术后膝关节功能恢复的影响。方法对拟行初次单侧全膝关节置换术的110例膝骨性关节炎患者随机分3组。A组30例将2 g氨甲环酸稀释于100 ml的生理盐水后在松止血带前经引流管向关节腔灌注（氨甲环酸组）；B组39例将100 ml生理盐水在松止血带前经引流管向关节腔灌注（对照1组）；前两组灌注结束后立即夹闭引流管3 h。C组41例同时点同样方式等量生理盐水关节腔灌注（对照2组），不夹管。3组患者性别、年龄、体重指数（BMI）等比较，差异均无统计学意义。 结果对比3组术中的出血量、术后的引流量、隐性失血量、总失血量、输血量和输血率的差异，术后膝关节肿胀程度、下肢瘀斑面积〉1%的发生率及术后5 d、1个月的膝关节活动度和膝关节协会评分系统（KSS）功能评分，差异均有统计学意义。术后静脉血栓栓塞症的发生率差异无统计学意义（P＝0.971）。 结论将2 g氨甲环酸（TXA）稀释于100 ml生理盐水后在松止血带前向关节腔灌注并夹管3 h，可以显著减少初次单侧人工全膝关节术（TKA）后的失血量、输血量与输血率，并且不增加血栓形成等并发症的发生风险。在TKA中关节腔灌注TXA还有利于患者术后膝关节早期的功能恢复。

To analyze the impact of blood loss and postoperative functional rehabilitation of primary unilateral total knee arthroplasty （TKA） with application of intra-articular traneamic acid （TXA） injection and clamping the drainage tube for 3 h. Methods From February 2014 to Augest 2015, 110 patients with knee osteoarthritis undergoing primary unilateral TKA were randomly divided into TXA group, first control group and second control group. There were 30 patients in the TXA group, 39 patients in the first control group and 41 patients in the second control group. TXA （2.0 g dissolved in 100 ml normal saline） or placebo （100 ml normal saline） was prepared. Patients in TXA group were injected with TXA （2.0 g dissolved in 100 ml normal saline） into intra-articular by drainage tube before deflation of the tourniquet. Patients in first control group and second control group were injected with normal saline （100 ml） into intra-articular by drainage tube before deflation of the tourniquet. In the TXA group and first control group, the drainage tube was clamped for 3 h immediately after injection. In the second control group, the drainage tube was not clamped. Gender, age, and body mass index （BMI） showed no significant differences among the three groups. Results There was statistically significant difference among the three groups in postoperative drainage volume, hidden blood loss, total blood loss, transfusion volume and rate, degree of knee joint swelling, the incidence of postoperative lower extremity ecchymosis area 〉1%, ROM and knee association score （KSS） function scores on the fifth day and first month after operation, but postoperative venous thrombus embolism showed no statistically significant difference （P=0.971）. Conclusion Injection of TXA （2.0 g dissolved in 100 ml normal saline） into intra-articular by drainage tube before deflation of the tourniquet significantly reduced hidden blood loss and transfusion volume and rate in primary TKA and did not increase the risk of venous thromboembolisms or other adverse events, and it is beneficial to the early functional recovery of knee joint after operation.