氨甲环酸对膝关节内侧单间室置换术后失血量的影响

Effect of tranexamic acid on blood loss in medial unicompartmental knee arthroplasty

[目的]探讨关节腔内注射氨甲环酸对膝关节内侧单间室置换术后失血量的影响。[方法]选择本科2016年1月～2017年1月期间骨关节炎需要行膝关节内侧单间室置换术的患者60例,分为两组,每组各30例,氨甲环酸组即手术完成后松止血带前从引流管向关节腔内注射20 ml(1 000 mg)氨甲环酸。对照组采用经引流管向关节腔内注入生理盐水20 ml,两组术后均夹闭引流管4 h,术后2 d拔出引流管。分别比较两组患者围手术期临床与血液检测指标。[结果]两组手术时间、切口长度以及住院天数比较差异无统计学意义(P>0.05),但氨甲环酸组术后24h和术后48 h的总引流量均显著低于对照组,差异有统计学意义(P<0.001),而术后2 d的Hb、Hct值显著高于对照组,差异有统计学意义(P<0.05)。此外,两组间术后2 d和2周的VAS评分差异均无统计学意义(P>0.05);两组间术后2周和6个月的膝关节功能HSS评分差异均无统计学意义(P>0.05)。术后1周两组行彩超检查均未见有双下肢深静脉血栓形成。[结论]关节腔注射氨甲环酸能够显著减少膝关节内侧单间室置换术后的出血量,不增加术后血栓形成的风险。

[Objective] To investigate the effect of intraarticular injection of tranexamic acid （TXA） on blood loss in medial unicompartmental knee arthroplasty （UKA）. [Methods] From January 2016 to January 2017, 60 patients who were intended to undergo UKA for unilateral medial compartment osteoarthritis were randomly divided into two groups with 30 patients in each group. The patients in TAX group had 20 ml （1 000 mg） TXA intraarticularly injected just before tourniquet released, whereas those in the control group got same volume of normal saline instead of TXA. The drainage tubes were closed by clips for the first 4 hours,and removed at 2 days after operation in both group. The perioperative clinical and hematological parameters were compared between the two groups. [Results] Although no statistically significant differences were noted in the operation time, the length of the incision and hospital stay between the two groups （P〉0.05）, the TXA group proved significantly less drainage volume than the control group at 24 and 48 hours （P〈0.05） . Conversely, the TXA group had statistically higher hemoglobin and hematocrit than the control group at 2 days postoperatively （P〈0.05） . Otherwise, no significant differences were noticed between the two groups in the VAS score at 2 days and 2 weeks, as well as HSS score at 2 weeks and 6 months after operation （P 〉 0.05） .No deep vein thrombosis inthe lower limbs was revealed by color ultrasound examination in anyone of the patients in both groups. [Conclusion] Intraarticular injection of tranexamic aciddoes significantly reduce the bleeding in unicompartmental knee arthroplasty without increase of risk for postoperative thrombosis.