全膝关节置换中关节腔灌注联合关节囊周围注射氨甲环酸与术后失血量的关系

Relationship between intra-articular infusion combined with peri-articular injection of tranexamic acid and postoperative blood loss after total knee arthroplasty

背景:氨甲环酸是一种人工合成氨基酸,可阻断纤维蛋白溶酶原的赖氨酸结合位点,以减少纤维蛋白溶解从而减少失血,被广泛应用于减少全膝关节置换围术期出血。目的:对比关节腔灌注联合关节囊周围注射与单纯关节腔灌注氨甲环酸对全膝关节置换后失血量的影响。方法:75例被诊断为单侧膝关节骨性关节炎需行全膝关节置换的患者被随机分为2组,术前30min均静脉滴注生理盐水250mL+氨甲环酸1g。单纯关节腔灌注组关节囊缝合完毕松止血带前经关节囊周围软组织注射100mL“鸡尾酒”,通过引流管向关节腔注入氨甲环酸3.0g+50mL生理盐水;关节腔灌注联合关节囊周围注射组(联合组)于关节囊缝合完毕松止血带前向关节囊周围软组织注射100mL“鸡尾酒”+1.5g氨甲环酸,并通过引流管向关节腔注入50mL生理盐水+3.0g氨甲环酸。2组患者对治疗方案均知情同意,且得到医院伦理委员会批准。术后记录患者24h引流量、术后第3天失血量及术后凝血功能、目测类比评分、膝关节活动度、输血率、切口感染率、肺栓塞、深静脉血栓发生率。结果与结论:①联合组术后24h引流量、第3天失血量均较单纯关节腔灌注组减少,差异有显著性意义(P<0.05);②2组患者术后膝关节活动度、目测类比评分及凝血功能差异无显著性意义(P>0.05);③单纯关节腔灌注组1例患者需要输血,2组均未发生切口感染、下肢深静脉血栓及肺栓塞;④结果证实,关节腔灌注联合关节囊周围注射氨甲环酸可显著减少全膝关节置换患者术后失血量,且不会增加术后血栓形成的风险。

BACKGROUND: Tranexamic acid is a synthetic amino acid, and can block the lysine binding site of plasminogen to reduce fibrinolysis and blood loss. It is widely used to reduce perioperative bleeding in total knee arthroplasty. OBJECTIVE: To evaluate the effect of intra-articular infusion combined with peri-articular injection versus intra-articular infusion of tranexamic acid on blood loss after total knee arthroplasty. METHODS: Totally 75 patients with unilateral knee osteoarthritis who underwent total knee arthroplasty were randomly divided into two groups. Both groups were intravenously injected with normal saline 250 mL+tranexamic acid 1 g 30 minutes before surgery. For the intra-articular infusion group, peri-articular injection with 100 mL cocktail was performed after the closure of articular capsule and intra-articular infusion with tranexamic acid (3.0 g+normal saline 50 mL) was also performed after surgery. For the intra-articular infusion combined with peri-articular injection group, peri-articular injection with 100 mL cocktail+1.5 g tranexamic acid was performed after the closure of articular capsule and intra-articular infusion with normal saline 50 mL+3.0 g tranexamic acid was also performed after surgery. Patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The 24-hour drainage, blood loss, coagulation function, visual analogue scale score, knee joint mobility, blood transfusion rate, incision infection rate, pulmonary embolism and deep vein thrombosis were recorded on the third day after operation. RESULTS AND CONCLUSION:(1) The intra-articular infusion combined with peri-articular injection group resulted in less postoperative 24-hour drainage volume and 3rd day’s blood loss postoperatively (P < 0.05).(2) There was no obvious statistical difference in range of motion, visual analogue scale score, and coagulation function between two groups (P > 0.05).(3) There was only one patient who received the transfusion treatment in intra-articular infusion group. There was no wound infection, deep venous thrombosis or pulmonary embolism in the two groups.(4) These findings demonstrated that intra-articular infusion combined with peri-articular injection of tranexamic acid can significantly reduce the postoperative blood loss in total knee arthroplasty without increasing the risk of thrombosis.