氨甲环酸对直接前方入路和后外侧入路初次全髋关节置换失血量影响的对比

Comparison of the Effect of Tranexamic Acid on Blood Loss in Primary Total hip Arthroplasty by Direct Anterior Approach and Posterolateral Approach

目的:探讨氨甲环酸(TXA)在后外侧入路和直接前方入路初次单側全髋关节置换中减少出血的效果对比。方法:回顾性收集、筛选、对比、分析80例在安徽医科大学第二附属医院骨科行单侧初次全髋关节置换的病人,根据是否使用氨甲环酸和手术入路的不同随机分成4组,直接前方入路氨甲环酸组(DAA-TXA)和对照组(DAA)、后外侧入路氨甲环酸组(PLA-TXA)和对照组(PLA)。氨甲环酸组切皮前5-10分钟和关闭切口前分别予以lg/100ml生理盐水静脉滴注和0.5g局部应用,对照组木前、术中均不使用TXA,且术后常规抗凝治疗。分析各组总失血量、术中失血量、隐性失血量及血栓形成率。结果:直接前方入路的手术时间和切口长度均短于后外侧入路组(P<0.05)。DAA-TXA组与DAA对照组相比总出血量减少了362.2ml(39.6%),显性失血量减少103.2ml(28.5%),隐性失血量减少了259ml(46.9%),差异均有统计学意义(P<0.05)。PLA-TXA组与PLA对照组相比总失血量减少了565.5ml(43.4%),显性失血量减少160.1ml(31.9%),隐性失血量减少了405.4ml(50.5%),差异均有统计学意义(P<0.05)。术后PLA组出现1例小腿深静脉血栓,DAA-TXA组和PLA组各出现1例肌间静脉血栓。结论:氨甲环酸对DAA入路和PLA入路全髋关节置换均有显著减少总失血量和隐性失血量的作用,且对PLA入路效果更明显,同时不增加术后血栓形成的风险。

Objective:To compare the effect of tranexamic acid(TXA)in reducing bleeding in the first unilateral total hip arthroplasty(THA)by posterolateral approach(PLA)and direct anterior approach(DAA).Methods:A total of 80 patients who underwent unilateral primary THA in the Department of orthopedics of the second affiliated hospital of Anhui medical university were retrospectively col-lected,screened,compared and analyzed.They were randomly divided into 4 groups:tranexamic acid group(DAA-TXA),control group(DAA),posterolateral approach tranexamic acid group(PLA-TXA)and control group(PLA)according to the use of TXA and surgical approach.DAA-TXA group was given intravenous drip of lg/lOOml saline and local application of 0.5g lg/lOOml before skin incision and before incision closure,respectively.The control group did not use TXA,before and during operation and routine anticoagu-lation therapy after operation.The total blood loss,intraoperative blood loss,recessive blood loss and thrombus formation rate in each group were analyzed.Results:The operation time and incision length of DAA are shorter than that of PLA.(P<0.05).Compared with the DAA control group,the total blood loss in the DAA-TXA group decreased by 362.2ml(39.6%),the dominant blood loss decreased by 103.2ml(28.5%),and the recessive blood loss decreased by 259ml(46.9%).The difference was statistically significant(P<0.05).Compared with the PLA control group,the total blood loss in the PLA-TXA group decreased by 565.5ml(43.4%),the dominant blood loss decreased by 160.1ml(31.9%),and the recessive blood loss decreased by 405.4ml(50.5%).The difference was statistically significant(P<0.05).After operation,there was 1 case of leg deep vein thrombosis in PLA group,1 case of intermuscular vein thrombosis in DAA-TXA group and 1 case in PLA group.Conclusion:TXA can significantly reduce the total blood loss and occult blood loss in THA via DAA and PLA,and has a more obvious effect on PLA,and does not increase the risk of postoperative thrombosis.