冷疗联合氨甲环酸应用对全膝关节置换术后局部反应的影响

Effect of cryotherapy combined with tranexamic acid on local reaction secondary to total knee arthroplasty

[目的]探讨冷疗联合氨甲环酸(TXA)应用对全膝关节置换(TKA)术后早期局部反应的影响。[方法]将行初次单侧全膝关节置换术患者共90例纳入本研究,并随机分为三组。其中,30例患者TKA术前静滴TXA 1 g(静滴TXA组),30例在静滴TXA的基础上,关闭切口时关节腔注入TXA 1 g(联合TXA组),30例在联合TXA组的基础上术后进行冷疗(冷疗组)。比较三组患者术后早期疼痛、肿胀、关节活动度。[结果]三组患者均顺利手术,三组患者术中失血量差异无统计学意义(P>0.05),但是,术后引流量依次为静滴TXA组>联合TXA组>冷疗组,差异有统计学意义(P<0.05)。随术后时间推移,三组患者VAS评分和股部周径差均显著减少,而ROM显著增加(P<0.05)。术后相应各时间点,VAS评分和股部周径差依次为静滴TXA组>联合TXA组>冷疗组,差异有统计学意义(P<0.05);而ROM依次为静滴TXA组<联合TXA组<冷疗组,差异有统计学意义(P<0.05)。[结论]冷疗联合TXA应用可减轻全膝关节置换术后早期局部反应。

[Objective]To investigate the effect of cryotherapy combined with tranexamic acid(TXA)on early local reaction after total knee arthroplasty(TKA).[Methods]A total of 90 patients who were undergoing primary unilateral TKA for endstage knee osteoarthritis were included into this study,and randomly divided into 3 groups.Of them,30 patients received intravenous TXA 1 g preoperatively(the iv TXA group),30 patients were added intraarticular TXA 1 g before closing the capsule on the basis of the IV TXA group(the combined TXA group),while the remaining 30 patients were added cryotherapy after TKA on basis of the combined TXA group(the cryotherapy group).The visual analogue scale(VAS)for pain,difference of bilateral thigh circumference and range of motion were compared among the 3 groups.[Results]All patients in the 3 groups had TKA performed smoothly.Although no a statistically significant difference was found in intraoperative blood loss among the 3 groups(P>0.05),the postoperative drainage volume ranked as the IV TXA group>the combined TXA group>the cryotherapy group with a statistically significant difference(P<0.05).As time went postoperatively,the VAS score and difference of bilateral thigh circumference significantly declined,whereas the ROM significantly increased in the 3 groups(P<0.05).At any matching time point postoperatively,the VAS score and difference of bilateral thigh circumference ranked in sequence of IV TXA group>the combined TXA group>the cryotherapy group,whereas the ROM ranked as IV TXA group<the combined TXA group<the cryotherapy group,which were of statistical significance(P<0.05).[Conclusion]The cryotherapy combined with tranexamic acid does relieve early local reaction after TKA.