氨甲环酸改善单侧全膝关节置换术后疼痛疗效观察

Effect of tranexamic acid on the pain after unilateral total knee arthroplasty

【目的】探讨氨甲环酸(tranexamic acid,TXA)对单侧全膝关节置换术(total knee arthroplasty,TKA)后疼痛的影响。【方法】40例单侧TKA患者随机分为两组(常规组:20例不使用TXA;TXA组:20例于术中及术后应用TXA),收集两组患者性别、年龄、体质指数、VAS评分(术前、术后3 d、1周、2周及1月)、膝关节活动度(range of motion,ROM:术后1周、2周及1个月)、髌上10 cm大腿周径变化率(术后1周、2周及1个月)及隐性失血量,并进行统计学分析。【结果】两组术前资料比较差异无统计学意义(P>0.05),具有可比性。TXA组术后1周VAS评分(3.1±0.9)分显著低于常规组(6.4±1.8)分(t=5.275,P<0.001)。TXA组术后1周ROM(96.5±6.4)度显著高于常规组(84.1±5.6)度(t=4.602,P<0.001)。TXA组术后1周及2周髌上10 cm大腿周径变化率显著低于常规组(t=3.113、2.697,均P<0.05)。TXA组术后隐性出血量明显低于常规组[(417±50)ml比(618±48)ml,t=-9.11,P<0.001]。两组术后3 d、2周及1个月VAS评分差异无统计学意义(t=0.105、1.644、0.071,均P>0.05)。两组术后2周及1个月ROM差异无统计学意义(t=1.989、0.628,均P>0.05)。两组术后1个月髌上10 cm大腿周径变化率差异无统计学意义(t=0.149,P>0.05)。【结论】TXA可明显减少初次TKA患者术后隐性出血,并可以间接降低术后疼痛,促进患者早期功能康复。

【Objective】To investigate the effect of tranexamic acid (TXA) on the pain after unilateral total knee arthroplasty (TKA).【Methods】A total of 40 patients with TKA were selected and randomly divided into two group: routine group (without TXA) and TXA group (with TXA in and after the operation), 20 cases per group. The following data were collected and statistically analyzed between the groups: gender, age, body mass index, visual analogue scale(VAS) score (preoperative;3 d,1 w and 1 m after the operation), range of motion (ROM)(1 w, 2 w and 1m after the operation), changing rate of thigh circumference at 10 cm above the upper edge of patella (1 w, 2 w and 1 m after the operation) and recessive blood loss.【Results】There was no significant difference in preoperative data between the two groups (P>0.05). The VAS sore in the TXA group was significantly lower than that in the routine group 1 w after the operation [(3.1±0.9) vs (6.4±1.8), t=5.275, P<0.001]. Knee ROM in the TXA group 1 week after the surgery was significantly higher than that in the routine group [(96.5±6.4) vs (84.1±5.6), t=4.602, P<0.001]. The changing rates of thigh circumference at 10 cm above the upper edge of patella in the TXA group 1 w and 2 w after the surgery were both significantly lower than those in the routine group (t=3.113, 2.697, both P<0.05). Recessive blood loss of TXA group was significantly less than that in the routine group [(417±50) vs (618±48) ml, t=-9.11, P<0.001]. There was no statistically significance in the VAS score at 3 d, 2 w and 1 m after the surgery between the two groups (t=0.105, 1.644, 0.071, P>0.05). There was no significant difference in knee ROM 2 w and 1 m after the surgery between the two groups (t=1.989, 0.628, both P>0.05). Changing rates of thigh circumference at 10 cm above the upper edge of patella 1 m after the surgery between the two groups showed no statistically significance (t=0.149, P>0.05).【Conclusion】TXA can obviously decrease the recessive blood loss, reduce the postoperative pain indirectly in the first unilateral TKA, and promote patients' early functional rehabilitation.